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Research article | DOI: https://doi.org/10.31579/2694-0248/030
1 Senior Consultant, Department of Orthopedics, Yashoda Superspeciality Hospital, Ghaziabad,
2 Professor&HOD, Dept. of Orthopaedics, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India,
3 Consultant, Department of Orthopaedics, Yashoda Superspeciality Hospital, Ghaziabad,
4 Junior Resident, Department of Orthopedics, Yashoda Superspeciality Hospital, Ghaziabad.
5 Post Graduate, Dept. of Orthopaedics, Santosh Medical College and Hospital,
*Corresponding Author: Amit Dwivedi, Professor&HOD, Dept. of Orthopaedics, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India.
Citation: Vipin Tyagi, Amit Dwivedi, Rahul Kakran, Shriya Garg, Robium Naorem (2022). Assessment of the Outcome of Acetabulum Fractures by Open Reduction and Internal Fixation with Plating: A Retrospective Study. J. Clinical Orthopedics and Trauma Care, 4(3); DOI:10.31579/2694-0248/030
Copyright: © 2022 Amit Dwivedi, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 18 January 2022 | Accepted: 03 February 2022 | Published: 21 February 2022
Keywords: acetabulum; pelvis; plating; stoppa approach; ilioinguinal approach; harris hip score
Introduction
Acetabular fractures are one of the most challenging and complex injuries encountered by the orthopedic surgeons. Because the acetabulum involves a major weight bearing joint in the lower limb, these fractures are of great clinical importance. The main aim in such fracture management is the proper anatomical reduction for the good functioning of the hip joint.
Aims and Objective
In this study, our aim is to assess the outcome of the acetabular fractures operated by open reduction and internal fixation with plating.
Materials and Methods
In this retrospective study, we included 30 patients with acetabular injuries who needed surgical intervention as per the indications. The patients were selected according to the inclusion and exclusion criteria. The patients were operated between November 2019 to December 2020 at Yashoda Superspeciality Hospital, Nehru Nagar, Ghaziabad.
Results
Follow up of the patients was done at 6, 8 and 12 weeks and 6 and 12 months. The patients were assessed according to the Modified Harris Hip Score.
Out of the 30 patients included in this study, 26 patients had excellent result, 3 patients had good result and 1 patient had fair result who developed stitch line infection which was treated with antibiotics.
Conclusion
All the patients operated had successful outcome with weight bearing, mobilization, and return to normal life and activities of daily living. Ilioinguinal, stoppa approach and KL approach have good outcome and the choice depends on the operating surgeon and the configuration of fracture.
Acetabular fractures are one of the most challenging and complex injuries encountered by the orthopedic surgeons [1, 2]. Because the acetabulum involves a major weight bearing joint in the lower limb, these fractures are of great clinical importance. The main aim in such fracture management is the proper anatomical reduction for the good functioning of the hip joint [3, 4].In cases with undisplaced acetabulum fractures and some less severe fractures, closed reduction can be done for achieving the anatomical reduction, but mostly open reduction and stabilizing the acetabulum with internal fixating devices is needed. The most common mechanism of such injuries are road traffic accidents, fall in elderly population, or a direct injury over the acetabulum [5, 6, and 7]. Earlier such surgeries were less often done due to lack of technology, other associated injuries, or severe comminution as in many cases. But with the advancement in the technology and better fixation devices, such fractures are increasingly stabilized with the internal fixation [8, 9].
In this retrospective study, we included 30 patients with acetabular injuries for surgery. The patients were selected according to the inclusion and exclusion criteria.
Inclusion criteria- 1. Patients with unilateral or bilateral acetabulum injury with AO Type A,Type B and Type C fracture. 2. Age > 20 years. 3. Patients without any comorbidities. 4. Patients who were fit for surgery.
Exclusion criteria- 1. Polytrauma patients with fracture of other bones. 2. Patients with co-morbidities. 3. Patients unfit for surgery. 4. Undisplaced fractures stabilized with closed reduction.
The patients were operated between November 2019 to December 2020 at Yashoda Superspeciality.
Hospital, Nehru Nagar, Ghaziabad.
The patients were operated by ilioinguinal approach or modified Stoppa approach or KL approach as per the surgeon’s convenience
Follow up of the patients was done at 6, 8 and 12 weeks and 6 and 12 months. No weight bearing was done up to 6 weeks.
Partial weight bearing was done between 6 to 8 weeks. Full weight bearing was started from 12th week.
In this study, we included 30 patients who were having acetabulum injury, mode of injury in most of the cases was road traffic accidents and trauma.
The patients were assessed according to the Modified Harris Hip Score.
Out of the 30 patients included in this study, 26 patients had excellent result, 3 patients had good result and 1 patient had fair result who developed stitch line infection which was treated with antibiotics.
Acetabular fractures are one of the most challenging and complex injuries encountered by the orthopedic surgeons. Earlier such surgeries were less often done due to lack of technology, other associated injuries, or severe comminution as in many cases. But with the advancement in the technology and better fixation devices, such fractures are increasingly stabilized with the internal fixation [11, 12].
The advantage of the stoppa approach is that it is a time sparing approach, better visualization of the neurovascular bundles, easy access to both the pelvis and acetabulum, less complications and less wound drainage while disadvantage is tension on the femoral vessels while retracting the anterior abdominal wall, damage to peritoneum while reduction, two experienced orthopedic surgeons are needed for the surgery.
The advantage of the ilioinguinal approach is that entire internal iliac fossa can be assessed. Disadvantage is that it is time consuming, more complications, it needs three windows, damage to the femoral vessels and more wound drainage.
The patients were operated using the stoppa approach, the ilioinguinal approach and KL approach, the decision was according to the operating surgeon.
Blood loss during the intraoperative period in the patients operated by ilioinguinal approach was 1175 ± 100 ml while in patients operated by stoppa approach was 1010 ± 100 ml. the less blood loss in stoppa approach might be because of shorter operative period and less wound drainage.
We assessed the patients according to the Modified Harris Hip Score had no significant difference in the approaches. Final radiological results and the quality of reduction in stoppa approach were found to be better than in those with ilioinguinal approach. Cancellous bone grafting and reduction without dislocating the joint must be the reason for the better radiological results with the stoppa approach [13].
One patient, who was operated with ilioinguinal approach developed suture line infection, which was managed by the antibiotics. The patients follow up was done at at 6, 8 and 12 weeks and 6 and 12 months.
All the patients operated had successful outcome with weight bearing, mobilization, and return to normal life and ADL (activities of daily living). Our study concludes that either of the approach could be used for the acetabulum fractures as per the convenience of the operating surgeon. The approaches, ilioinguinal and stoppa approach, KL approach have good outcome and the choice depends on the operating surgeon and the type and pattern of fracture. Blood loss was less in Stoppa approach and might be due to short operative time and less wound drainage.
Conflict of interest statement:
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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