Surgical hip dislocation in fixation of acetabular fractures: Extended indications and outcome |
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Institution: | 1. Department of Orthopaedic, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China;2. Department of Traditional Chinese Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China;1. Department of Orthopedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA;2. R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA;1. The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia;2. The Australian National University, Canberra, Australian Capital Territory, Australia;3. The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia;1. Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305-5101, United States of America;2. Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, United States of America;3. Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States of America |
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Abstract: | BackgroundSurgical hip dislocation has been described as an excellent method for reduction and fixation of acetabular fractures. It allows a 360-degree access to the acetabulum and acetabular dome. However, reproducibility of this technique is still a concern. The primary outcome of this study was to investigate the short term functional and radiological outcome with the use of surgical hip dislocation in acetabular fractures. The secondary outcome was to describe different indications and methods of reduction using this technique.MethodsThis is a retrospective consecutive case series for the use of surgical hip dislocation in acetabular fractures. Between July 2013 and February 2017, we used this technique to manage 36 cases of acetabular fractures. Two patients were lost to follow up leaving 34 patients eligible for the study. All surgeries were done by a 5-years and a 10-years’ experience surgeons in pelvic and acetabular trauma surgeries. Through Gibson approach, we used the technique of surgical hip dislocation as described by the Bernese group. Different methods of fracture reduction were used. Intraoperative grading of cartilage injury was done using Disler's grading system. Postoperative fracture reduction was evaluated using the criteria described by Matta. Clinical evaluation was done using the modified Merle d'Aubigne ? and Postel system.ResultsThe mean intra-operative blood loss was about 700 ± 35.4 ml. The mean units of blood transfused were 1 ± 0.1 unit. The mean surgical time was 135 ± 11.7 minutes.Anatomical reduction was achieved in 27 patients (79.4%). At a mean of 30 ± 16.8 months (median = 26 and IQR 22) follow up, the functional score was excellent in 5 (14.7 %), very good in 8 (23.5%), good in 9 (26.5%), fair in 2 (5.8%), and poor in 10 (29.4%) patients. Four patients (11.7%) developed AVN at a mean of 8 months postoperatively. Conversion to THA was done in 5 patients (14,7%). Trochanteric osteotomy showed osseous healing in all cases. No patient developed nerve injury or infection. One patient developed severe (grade III) heterotopic ossification.ConclusionsBesides the indications of surgical hip dislocation mentioned before as reduction of the anterior column in T and Transverse fractures, associated femoral head fractures, intraarticular fragments, and labral injuries, it can be used in other indications as entrapped posterior wall, roof impaction, pure impaction injuries and cranial extension of the posterior wall fractures. The technique is reproducible; however, the learning curve is steep and needs to be performed by experienced acetabular trauma surgeons. |
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