Treatment of complex acetabular fractures through a modified extended iliofemoral approach

OBJECTIVES: To assess the rate of anatomic reconstructions as well as approach-related morbidity and complications in the treatment of complex acetabular fractures through a modified extended iliofemoral approach. DESIGN: Prospective clinical study. SETTING: Level I trauma center, University Hospital. PATIENTS: Inclusion criteria were as follows: (a) associated acetabular fracture or transverse fracture with comminuted roof area stated as not sufficiently reconstructable through a single approach, and (b) age between sixteen and sixty-five years. A total of forty-nine patients with fifty complex acetabular fractures could be included out of the series of ninety-six acetabular fractures treated operatively from August 1992 to February 1996. Open reduction and internal fixation of complex acetabular fractures through the modified extended iliofemoral approach were performed. RESULTS: In 80 percent of the fifty fractures the reduction was anatomic with a remaining displacement of less than or equal to one millimeter, in eight cases there was a persistent displacement of two millimeters, and two fractures had a poor result with a three-millimeter displacement. Complications included 8 percent loss of reduction, 13 percent heterotopic ossification grade 3, and 4 percent avascular femoral head necrosis. At the two-year follow-up there were 74 percent good or excellent radiographic and clinical results. Two patients had already been reoperated with total hip replacement, and the two patients with femoral head necrosis are currently scheduled for arthroplasty. CONCLUSIONS: The modified extended iliofemoral approach proved to be appropriate to achieve anatomic reduction in complex acetabular fractures. The high rate of approach-related morbidity has to be considered carefully and may lead to a decreased incidence of extended approaches.     

Long-term results in surgically treated acetabular fractures through the posterior approaches

BACKGROUND: The long-term results of surgically treated displaced acetabular fractures using the posterior approaches and the possible role of the greater trochanteric osteotomy in the development of heterotopic ossification (HO) are still somehow controversial despite extensive publications. METHODS: Seventy-five patients with an acetabular fracture and displacement of at least 3 mm were surgically treated during a 6-year period. The duration of the follow-up was from 10 to 15 years, with a mean of 12.5 years. RESULTS: The over-all satisfactory clinical result, grouping together the excellent and good results, was 80%. There was a good correlation between clinical and radiologic results. The most common complication was HO, observed in 19 patients (25.3%). The extended iliofemoral approach had the greater incidence of HO (40%), whereas the least was observed in the Kocher-Langenbeck approach with osteotomy of the greater trochanter (21.4%). Moreover, posttraumatic osteoarthrosis was observed in eight patients (10.7%) and osteonecrosis of the femoral head in six (8%). CONCLUSIONS: Surgical treatment of the acetabular fractures aiming at anatomic reduction of the acetabulum and congruency with the femoral head is the prerequisite for a favorable functional outcome in the long term. In most cases, the Kocher-Langenbeck approach is adequate. Trochanteric osteotomy is indicated only for fractures extending toward the anrerior column and this facilitates exposure, anatomic reduction, and fixation. No statistically significant difference was found between the surgical approach and heterotopic bone formation.     

Simultaneous anterior and posterior approaches for complex acetabular fractures

Simultaneous Kocher-Langenbeck and iliofemoral exposures of the acetabulum are a safe and useful alternative to other extensile exposures and can be performed with similar morbidity. The advantages of simultaneous anterior and posterior approaches over extensile exposures include the absence of a trochanteric osteotomy. The combined approach is most useful in transverse, transverse posterior wall fractures with wide anterior displacement, T type fractures with significant anterior-inferior displacement, or both column fractures with posterior wall involvement.     

Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management

Background:

Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. Adequate visualization of some acetabular fracture types may necessitate extensile or combined anterior and posterior approaches. Simultaneous anterior iliofemoral and posterior Kocher-Langenbeck (K-L) exposures with two surgical teams have also been described. To assess whether modified Kocher-Langenbeck (K-L) approach can substitute standard K-L approach in the management of elementary acetabular fractures other than the anterior wall and anterior column fractures and complement anterior surgical approaches in the management of complex acetabular fractures.

Materials and Methods:

20 patients with transverse and associated acetabular fractures requiring posterior exposure were included in this prospective study. In 9 cases (7 transverse, 1 transverse with posterior wall, and 1 posterior column with posterior wall), stabilization was done through modified K-L approach. In 11 cases (3 transverse and 8 associated fractures), initial stabilization through iliofemoral approach was followed by modified K-L approach.

Results:

The average operative time was 183 min for combined approach and 84 min for modified K-L approach. The postoperative reduction was anatomical in 17 patients and imperfect in 3 patients. The radiological outcome was excellent in 15, good in 4, and poor in one patient. The clinical outcome was excellent in 15, good in 3 and fair and poor in 1 each according to modified Merle d’Aubigne and Postel scoring system.

Conclusion:

We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team.     

Screw fixation of acetabular fractures

Between 1992 and 1995, 50 patients with 51 acetabular fractures underwent internal fixation using 3.5 mm cortical screws. There were 21 simple and 30 associated fracture types, as described by Letournel. Most of the patients had sustained multiple injuries with an average injury severity score (ISS) of 20 points. The modified extended iliofemoral approach was used in 32 cases, the Kocher Langenbeck approach in 9 cases, the ilioinguinal approach in 7 cases, the extended iliofemoral in 2 cases and the Kocher-Langenbeck approach combined with an ilioinguinal approach in a second stage procedure in 1. Anatomical reduction could be achieved with persistent displacement of no more than 1 mm in 40 fractures. Implant failure with loss of reduction occurred in 3 patients who underwent a revision procedure. At 2 year follow-up, 38 out of 44 of the patients had excellent or good clinical and radiological results. In acetabular fractures with sufficiently large fragments, screw fixation with 3.5 mm cortical screws proved satisfactory. In very comminuted fractures or where there is poor patient compliance an additional buttress plate should be used.     

Prosthetic replacement in treatment of subcapital femoral neck fractures in the elderly

OBJECTIVE: To compare the results of femoral head replacement (FHR) and total hip replacement (THR) in treatment of subcapital femoral neck fractures (SFNF). METHODS: Between May 1987 and July 1998, 56 elderly patients (6 5-90 years; average 73.5 years) with SFNF were treated with prosthetic replacement. Six cases were treated with unipolar FHR, 18 cases with Bateman bipolar FHR, and 32 cases with Bateman bipolar THR. All domestic prostheses were installed with cement. RESULTS: There was no significant difference between the 2 groups in operating time and blood transfusion. Forty-nine patients were followed-up for an average of 5 years and 10 months. No wound infection or death was related to surgery. Complications in Group FHR were significantly higher than that i n Group THR. CONCLUSIONS: Since FHR is difficult to fit the bony acetabulum, it is only indicated for senile cases with poor conditions. However, the bi polar THR installed with cement is indicated for most elderly patients. Since th e femoral head and acetabulum can fit each other completely, it is more stable for taking weight-bearing earlier with less complications.     

Surgical treatment of displaced fractures of posterior column and posterior wall of the acetabulum

We evaluated the results of open reduction and internal fixation of displaced posterior wall and posterior column fractures of the acetabulum. This was a prospective clinical evaluation of such cases where the main surgical strategy was open reduction and internal fixation with interfragmentary screws and reconstruction plates. Data on 11 patients treated by open reduction (all via Kocher-Langenbech approach)/internal fixation with interfragmentary screws and reconstruction plates were collected. The follow-up period was 61 (18-102) months. Reduction with a fracture gap of less than 2mm without articular stepping was achieved in all 11 cases. Postoperative complications developed in five patients, including subcutaneous haematoma in one, avascular necrosis of the femoral head (AVNFH) in one and heterotopic ossification (HO) in three. All but the patient with AVNFH, had anatomic radiological reduction, and good to excellent functional results. Open reduction and internal fixation with interfragmentary screws and reconstruction plates is the treatment of choice in displaced posterior wall and posterior column fractures of the acetabulum.     

Operative treatment of acetabular fractures through the extensile Henry approach

OBJECTIVE: The purpose of this study was to evaluate the previously unreported application of the extensile Henry approach to the operative treatment of acetabular fractures. METHODS: Thirty-one cases were retrospectively reviewed at an average follow-up of 18.5 months. RESULTS: There were 8 simple and 23 complex associated fracture patterns. The average operative time was 4.5 hours, and the average blood loss was 1,160 mL. Reduction was anatomic in 26 patients (84%), satisfactory in 4 patients (13%), and unsatisfactory in 1 patient (3%). Radiographic results at follow-up were 25 excellent results, 4 good results, and 2 poor results. Twenty-six patients reported no limitation of ordinary activities, whereas five patients had to modify their activities because of pain. No heterotopic ossification occurred in 24 patients (77%). In the seven patients with heterotopic ossification, only one patient had a significant decrease in hip range of motion. Additional complications were two cases of superficial wound infection, one case of hardware failure, and two cases of avascular necrosis of the femoral head. There were no iatrogenic injuries to the sciatic nerve, nor was there any development of flap necrosis. CONCLUSION: The extensile Henry approach is a versatile approach offering an excellent exposure for surgical treatment of acetabular fractures. The rate of complications is comparable with or lower than that of other surgical approaches. By providing a direct exposure of the posterior pelvis, the extensile Henry approach has the advantage of minimizing the risk of iatrogenic injury to the sciatic nerve. In addition, the incidence of clinically significant heterotopic ossification may be reduced through the use of low-dose radiation prophylaxis.     

Complications following the "T extensile" approach: a modified extensile approach for acetabular fracture surgery-report of forty-three patients

OBJECTIVE: Analyze the prevalence and severity of surgical complications encountered with a modified extended iliofemoral approach, the "T extensile" approach, in the treatment of complex acetabular fractures. STUDY DESIGN: Prospective. METHODS: During a sixteen-month study period, forty-three patients with complex acetabular fractures were treated via the T extensile approach. Perioperative antibiotics were used to prevent infection, and prophylaxis for heterotopic ossification was done with postoperative irradiation. Complications and clinical results were recorded. The patients were followed for an average of thirty months. RESULTS: Acceptable reductions were obtained in forty patients. Poor reductions were obtained in three patients. There were no infections or iatrogenic nerve injuries. Brooker Grade 1 heterotopic ossification was seen in nineteen patients, eight had Grade 2, two had Grade 3, and no heterotopic ossification was seen in the other fourteen patients. No patient who received radiation developed heterotopic ossification beyond Brooker Grade 2. Seven patients went on to require total hip arthroplasty. The remaining thirty-six patients had an average Harris Hip Score of 86. CONCLUSIONS: Extensile exposures to the acetabulum can be safely carried out with limited morbidity, as long as appropriate steps are taken to limit predictable complications.     

Management of Acetabular Fractures in the Elderly Patient

Operative management of displaced acetabular fractures yields better results than nonoperative management. Over the past decade, surgical approaches to the acetabulum and the surgical tactic for repair of common fracture patterns have been advanced. Excellent outcomes after repair of these injuries can be achieved. In some cases, as in the elderly, or in those cases in which there is significant destruction of the articular cartilage, primary total hip arthroplasty may provide the best solution. Removal of the femoral head allows for excellent exposure of the acetabulum, making it possible to stabilize most fractures without the need for extensile or intrapelvic approaches. The surgical technique that has been successfully used calls for gaining primary stability of the acetabular columns by open reduction and internal fixation and then using the acetabular component to replace the articular surface. The columns need not be anatomically reduced. Multiholed acetabular shells can be used as internal fixation devices by placing screws into the columns enhancing the stability of the repair. In older individuals with severe osteoporosis, a typical fracture pattern results in intrapelvic dislocation of the femoral head with a blowout fracture of the anterior column and medial wall. Reinforcement rings with cemented acetabular fixation can be used in these cases. The femoral head can be used as bulk bone graft to replace and reinforce the reconstruction. Techniques common to revision of failed acetabular components are helpful in this setting. The results of reconstruction of severe acetabular fractures with total hip replacement have been reported to be similar to those achieved for reconstruction of osteoarthritis.     

Surgical management of intraarticular fractures of the calcaneus

In this study we evaluated the interim results of surgical management of intraarticular calcaneal fractures in 26 feet in 19 patients. The mean age of the 15 male and 4 female patients in our series was 28.3 (range 17-54) years. There were 7 bilateral and 12 unilateral fractures. We obtained anteroposterior (AP), lateral, and skyline views and computed tomography (CT) scans of all patients preoperatively. According to Sanders CT classification, we detected type II, III, and IV fractures in 12, 10, and 4 cases, respectively. We performed extended lateral incisions in all patients but one and used Sherman plate, screw, and staples to achieve anatomic reduction. The mean follow-up period was 38.2 (range 18-50) months. Patients were evaluated by X-ray, CT, and Maryland foot score. We found that anatomic reduction had been achieved in 20 cases as confirmed by X-ray and CT postoperatively. With regard to the Maryland foot score, excellent, good, fair, and poor results were obtained in 9, 11, 4, and 2 cases, respectively. None of our patients required secondary intervention. We conclude that in order to obtain satisfactory results in the management of intraarticular calcaneal fractures, anatomic reduction must be achieved and maintained using strength hardware.     

Safety and efficacy of the extended iliofemoral approach in the treatment of complex fractures of the acetabulum

There remains uncertainty about the most effective surgical approach in the treatment of complex fractures of the acetabulum. We have reviewed the experience of a single surgeon using the extended iliofemoral approach, as described by Letournel.A review of the database of such fractures identified 106 patients operated on using this approach with a minimum follow-up of two years. All data were collected prospectively. The fractures involved both columns in 64 (60%). Operation was undertaken in less than 21 days after injury in 71 patients (67%) and in 35 (33%) the procedure was carried out later than this. The reduction of the fracture was measured on plain radiographs taken after operation and defined as anatomical (0 to 1 mm of displacement); imperfect (2 to 3 mm) or poor (> 3 mm). The functional outcome was measured by the modified Merle d'Aubigné and Postel score. The mean follow-up was for 6.3 years (2 to 17).All patients achieved union of the fractures. The reduction was graded as anatomical in 76 (72%) of the patients, imperfect in 23 (22%), and poor in six (6%). The mean Merle d'Aubigné and Postel score was 15 (5 to 18) with 68 patients (64%) showing good or excellent and 38 (36%) fair or poor results. Function correlated significantly with the accuracy of the reduction (p < 0.009). Significant heterotopic ossification developed in 32 patients (30%) and was associated with a worse mean Merle d'Aubigné and Postel score of 13.7.The extended iliofemoral approach can be performed safely in selected complex acetabular fractures with an acceptable clinical outcome and rate of complications. Effective prophylaxis against heterotopic ossification should be strongly considered.     

Superior gluteal artery in the extended iliofemoral approach

OBJECTIVE: To determine the incidence of superior gluteal artery injury following fracture of the acetabulum and to determine whether the combination of a superior gluteal artery injury and the use of an extended iliofemoral approach to the acetabulum creates abductor muscle necrosis. DESIGN: Prospective protocol, consecutive cases. SETTING: A consecutive series from the referral practice of the senior author plus seven cases from the practices of two other authors. PATIENTS: Two hundred twenty-seven patients with fractures of the acetabulum were treated operatively between November 1992 and January 1995. Forty-one were treated with the use of the extended iliofemoral approach. Preoperative angiograms were not performed for any of the patients. All fractures involved the posterior column, and all but two fractures had displacement of the greater sciatic notch. The average displacement of the notch was 2.5 centimeters (range 6 to 60 millimeters). INTERVENTION: All patients were treated with open reduction and internal fixation via the extended iliofemoral approach. Intraoperative Doppler examination of the superior gluteal artery was performed before and after reduction and fixation of the posterior column. MAIN OUTCOME MEASURE: Wound complications, abductor manual muscle testing, hip range of motion. RESULTS: Pulsatile flow was confirmed in forty of forty-one patients. All patients were followed for a minimum of six months with an average follow-up of 1.4 years. At most recent follow-up, no patients had evidence of complete loss of abductor function. Sixty-three percent of patients had achieved Grade 4 of 5 motor strength, and 25 percent of them had achieved normal motor strength. CONCLUSIONS: No instances of superior gluteal artery laceration and only one instance of superior gluteal artery thrombosis were encountered in these forty-one patients despite significant fracture displacement involving the sciatic notch. The incidence of superior gluteal artery injury was significantly less than would be expected from previous studies. Massive abductor necrosis resulting from superior gluteal artery injury combined with an extended approach has been described primarily in animal and cadaver studies. Although arteriograms are useful in the control of hemodynamic instability, we cannot support the recommendation of preoperative angiographic study of all patients undergoing acetabular fracture surgery via an extended approach. In one case, an extended iliofemoral approach was tolerated in a patient with absent superior gluteal artery flow.     

髋臼合并同侧股骨颈骨折的手术治疗与预后

目的 探讨髋臼合并同侧股骨颈骨折的手术方法与预后.方法 1990年10月至2008年1月共收治7例髋臼合并同侧股骨颈骨折患者,其中男5例,女2例;年龄22～55岁(平均38.6岁).髋臼骨折按Letournel分类:后壁骨折2例,后柱伴后壁骨折1例,横行伴后壁骨折2例,双柱骨折2例.股骨颈骨折按Garden分型:Ⅲ型2例,Ⅳ型5例.其中X线片和CT片示股骨颈骨折合并股骨头游离脱位于髋臼后上方者5例,仅显示股骨颈骨折而无脱位者2例.结果切开复位内固定术后X线片示5例移位髋臼骨折患者获解剖复位,2例获满意复位.股骨颈骨折均获满意复位和固定.7例患者术后获1～18年(平均8.6年)随访,X线片示5例合并股骨头脱位者日后均出现股骨头缺血性坏死,坏死率高达100%(5/5),髋关节功能恢复均为差,于内固定术后2～4年改行全髋关节置换术.而2例股骨头未脱位者至今X线片上仍未显示任何股骨头坏死迹象,也无创伤后关节炎表现,髋关节功能恢复均为优.结论 髋臼合并同侧股骨颈骨折患者,如同时合并股骨头脱位,因股骨头坏死率高,应首选全髋关节置换术治疗.如未合并股骨头脱位,可以考虑首选切开复位内固定.     

Surgical treatment and prognosis of acetabular fractures associated with ipsilateral femoral neck fractures

Combined ipsilateral acetabular and femoral neck fractures are the result of high-energy trauma. Satisfactory treatment for this injury pattern remains a challenge, since traditional open reduction and internal fixation (ORIF) is always accompanied by a high prevalence of posttraumatic arthritis and avascular necrosis of the femoral head. Eight of 502 acetabular fractures from 1990 to 2008 were diagnosed with combined ipsilateral femoral neck fracture, in which 5 patients' fractures were associated with hip dislocation. These patients were injured from falls, traffic accidents, or crushing accidents. Radiographs and computed tomography scans were taken to check acetabular and femoral neck fractures. All of the patients underwent surgery using appropriate approaches and techniques. Postoperative radiographs demonstrated anatomic or satisfactory reduction for acetabular fractures as well as excellent or good reduction for femoral neck fractures in all of the patients. Follow-up radiographs showed femoral head necrosis in the 5 patients with femoral head dislocations, but not in the other 3 patients. We have seen few patients with this injury pattern, which makes us unable to detect significant differences between the patients associated with femoral head dislocation and those without femoral head dislocation. But by considering the results of our study and those reported in the literature, we believe that for patients with ipsilateral acetabular and femoral neck fractures without hip dislocation, satisfactory results could be expected after ORIF. But for those cases associated with hip dislocation, alternative methods such as acute THR as primary treatment are worthy of consideration.     

A modified extensile exposure for the treatment of complex or malunited acetabular fractures

A modification of the extended iliofemoral incision of Letournel and Judet facilitates the operative exposure of T-type, complex transverse, and both-column acetabular fractures and malunions. The modification includes the utilization of a T-shaped skin incision with large flaps, and osteotomies of the iliac crest, greater trochanter, and anterior superior iliac spine. The iliotibial band is transected and the abductor muscle mass is rotated posteriorly, hinged on the superior gluteal neurovascular bundle. Twenty patients had open reduction and internal fixation of a complex acetabular fracture using this surgical approach. Excellent surgical exposure allowed good or excellent reduction of the acetabulum in all patients. No flap necrosis developed, and all fractures healed. One non-union of a trochanteric osteotomy needed revision. This approach provides increased exposure of the posterior column and visualization of the entire surface of the joint and it allows fixation of the fracture from both sides of the iliac wing. The T-shaped skin incision allows utilization of a standard posterior approach with conversion to the extensile exposure if necessary. Options for late reconstruction are not compromised. Lagscrew fixation of the osteotomies allows aggressive rehabilitation of the joint.     

股骨颈骨折的内固定手术治疗

对于嵌插型股骨颈骨折应该同移位型股骨颈骨折一样考虑行手术治疗。移位型股骨颈骨折,若病人无手术禁忌证均应采取手术治疗,目前多数作者主张应予以急诊手术。移位型股骨颈骨折的治疗原则包括解剖复位、骨折端加压、稳定的内固定。应尽可能采取闭合复位,只有在闭合复位失败、无法达到解剖复位时才考虑切开复位。目前常用的内固定材料可分为多针、螺钉、钩钉、滑动螺钉加侧方钢板等,各有其优缺点及适应证。年青人股骨颈骨折的治疗原则,一是急诊手术(伤后12h之内);二是一定要解剖复位,必要时切开复位;三是多枚螺钉坚强固定;有作者补充提出前关节囊切开减压的必要。     

真骨盆缘完整的髋臼高位前柱骨折的治疗

 目的 探讨真骨盆缘完整的髋臼高位前柱骨折的治疗方法。方法 2006年 1月至 2010 年 1月, 治疗 12例真骨盆缘完整的髋臼高位前柱骨折, 男 8例, 女 4例;年龄 29~46岁, 平均 35.6岁;挤 压伤 7例, 压砸伤 3例, 高处坠落伤 2例。术前常规摄骨盆正位、闭孔斜位、髂骨斜位 X线片及 CT扫描。 根据是否合并后壁骨折及髂骨骨折块的完整性分为单纯型 5例, 合并后壁型 6例, 粉碎型 1例。 5例单纯型及 2例合并较小的无移位后壁型骨折者采用髂股入路行髂嵴支持钢板加髂骨前缘拉力螺钉固定; 4例合并明显移位的后壁型骨折者采用前后联合入路行拉力螺钉、支持钢板固定;1例粉碎型骨折采用 扩展髂股入路行钢板螺钉固定。结果 12例患者均获得随访, 随访时间 14~37个月, 平均 26.7个月。术后按 Matta影像学评定标准, 优 8例, 良 3例, 差 1;优良率为 92%。无一例发生骨折不愈合及内固定断 裂。末次随访按 Matta改良的 Merled爷Aubigne和 Postel功能评分系统评分为 11~18分, 平均 16.8分;优 7例, 良 4例, 差 1例;优良率为 92%。 1例发生异位骨化和轻度的创伤性关节炎。结论 选择合理的手 术入路、解剖复位、坚强固定是治疗真骨盆缘完整的髋臼高位前柱骨折的关键。     

Fractures of the acetabulum. Early results of a prospective study

One hundred two patients with 105 displaced fractures of the acetabulum were treated for fractures involving at least one column of the acetabulum and displaced at least 5 mm (rim fractures were excluded). The patients were primarily young adults with multiple injuries secondary to motor-vehicle-associated trauma. Fractures were classified according to the classification of Letournel. The most common fractures were the complex associated types with 44 complete both column, 19 T-shaped, and 18 associated transverse and posterior wall. Seventeen fractures were treated closed, and 88 were treated operatively. Closed treatment with skeletal traction was undertaken if roof arc measurements demonstrated a satisfactory remaining acetabular dome following fracture and in some cases of apparent congruence following complete both column fractures. Fractures not meeting these criteria were operated upon through the Kocher-Langenbeck, extended iliofemoral, or ilioinguinal approach. Ninety percent of the operations produced a satisfactory reduction of the fracture (3 mm or less displacement). A follow-up study longer than one year was obtained for 50 fractures. Clinical results were 80% satisfactory overall. Operative complications included 3% infection, 5% nerve palsy, and 7% significant ectopic bone. Operative treatment can produce satisfactory fracture reductions and clinical results with an acceptably low complication rate.     

对99例髋臼骨折内固定治疗的分析

从1972年11月到1994年3月,401例髋臼骨折病人中的99例经手术治疗并获随访,包括30例双柱骨折,13例横骨折伴后壁骨折,9例后壁骨折,9例后柱骨折,9例前往骨折伴前壁骨折,13例T形骨折和16例横骨折.平均随访时间为7年(2～14).外科手术入路的选择,后入路53次,髂腹股沟入路23次,延长的髂股骨入路11次,放射状入路9次和结合性入路6次.复位情况用X线平片来评判,解剖复位的有59例(59.6%),接近解剖复位(<2mm的错位)的有19例(19.2%).总结果用Harris Hip Score来评判,优秀的有53例(53.5%),良好的有25例(25.3%),一般的有14例(14.1%),差的有7例(7%).并发症中,有10例(53%)为感染,7例(37%)为静脉栓塞.这些结果表明,对于错位严重的髋臼骨折,切开复位内固定是一种可以选择的治疗方法.