Surgically Treated Posterior Acetabular Fractures Via Iselin’s Modified Approach with A Short-Term Follow-Up

Year 2019, , 93 - 99, 28.08.2019

Erdem Değirmenci , Zafer Orhan Mehmet Arıcan , Zekeriya Karaduman , Yalçın Turhan , Ozan Turhal

https://doi.org/10.19127/mbsjohs.561885

Cited By: 1

Abstract

Objective: The main purpose of the surgical
treatment of posterior acetabular fracture is to achieve anatomical reduction
to attain a functional and stable hip joint without pain. Although
Kocher-Langenbeck (K-L) approach is the most commonly used surgical exposure,
various modified approaches have been described in the literature. The aim of
this study to determine the early surgical results of the acetabulum posterior
fractures surgery via Iselin's modified K-L approach.

Methods: We reviewed the hospital records of
patients who were operated for acetabulum posterior wall fractures via Iselin's
modified approach between 2016 and 2018. All patients had detailed
radiological, clinical evaluation and fractures were classified by AO/ASIF classification.
All patients had radiological and clinical evaluation at the end of the
postoperative 1^st year.

Results: There were 16 men and 4 women with
an average age of 42.8±18.0 (range 18-77) years. The average follow-up was
14.8±6.1 (range 6-28) months. The right hip was involved in 12 (60%) patients
and the left in 8 (40%) patients. The average operative time was 78.6±16.7
(range, 54–115) minutes. Average blood loss during the operation was
179.22±51.9 (range, 100–260) ml. The postoperative reduction was graded as
anatomic (0–1 mm of displacement) for 17 hips and imperfect (2–3 mm of
displacement) for 3 patients. No patient had a deep infection, implant
loosening, recurrent dislocation, deep venous thrombosis (DVT), pulmonary
embolism (PE) or revision fixation.

Conclusion: The modified approach of Iselin is
a successful approach with its ease in the surgery of displaced fractures that
extending proximally and early radiological and functional results.

Keywords

Acetabulum Fracture, Posterior Wall, Modified Method of Iselin

References

• Baumgaertner MR. Fractures of the posterior wall of the acetabular. J Am Acad Orthop Surg 1999; 7:54–65.
• Brooker AF, Boweman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973;55(8):1629–32.
• Carr JB, Leach PB. Small-incision surgical exposure for select fractures of the acetabular: The gluteus maximus-splitting approach. J Orthop Trauma. 2006; 20:573–75.
• Chiu FY, Chen CM, Lo WH. Surgical treatment of displaced acetabular fractures: 72 cases followed for 10 (6–14) years. Injury 2000; 3:181–85.
• Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br) 1985;67(1):3–9.
• Ghalambor N, Matta JM, Bernstein L. Heterotopic ossification following operative treatment of acetabular fracture. An analysis of risk factors. Clin Orthop 1994; 305: 96–105.
• Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabular. A meta-analysis. J Bone Joint Surg Br 2005;87: 2–9.
• Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737–55.
• Helfet DL, Shonnard P. Mini-symposium: Acetabular fracture classification. Curr Orthop 1996;10: 69–73. Im GI, Chung WS. Fractures of the posterior wall of the acetabular: Treatment using cannulated screws. Injury 2004; 35 :782–86.
• Iselin LD, Wahl P, Studer P, Munro JT, Gautier E. Associated lesions in posterior wall acetabular fractures: not a valid predictor of failure. J Orthopaed Traumatol 2013; 14(3):179–84.
• Kaempffe FA, Bone LB, Border JR. Open reduction and internal fixation of acetabular fractures: heterotopic ossification and other complications of treatment. J Orthop Trauma 1991; 5(4):439–45.
• Letournel E, Judet R. Fractures of the acetabular. Second Edition. Berlin: Springer-Verlag; 1992.
• Liebergall M, Mosheiff R, Low J, Goldvirt M, Matan Y, Segal D. Acetabular fractures: Clinical outcome of surgical treatment. Clin Orthop Relat Res 1999; 366:205–16.
• Magu K.N, Paritosh Gogna, Singh G.A, Singla R, Rohilla R, Batra A. et al. Long term results after surgical management of posterior Wall acetabular fractures. J Orthopaed Traumatol 2014; 15 :173–79.
• Magu NK, Rohilla R, Arora S, More H. Modified Kocher- Langenbeck approach for the stabilization of posterior wall fractures of the acetabulum. J Orthop Trauma 2011; 25: 243–49.
• Matta JM. Fractures of the acetabular: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996; 78: 1632–45.
• Moed BR, WillsonCarr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabular. J Bone Joint Surg Am 2002; 84 :752–58.
• Negrin L, Seligson D. Results of 167 consecutive cases of acetabular fractures using the Kocher- Langenbeck approach: a case series. Journal of Orthopaedic Surgery and Research 2017; 12: 66.
• Porter SE, Schroeder AC, Dzugan SS, Graves ML, Zhang L, Russell GV. Acetabular fracture patterns and their associated injuries. J Orthop Trauma 2008; 22: 165-70.
• Rommens PM. The Kocher–Langenbeck approach for the treatment of acetabular fractures. Eur J Trauma 2004; 30: 265–73.
• Zinghi G.F, Bungaro P, Davoli O, Ponziani L, Rollo G, Trono M. Editors. Second Edition. Fracture of the pelvis and acetabular. Georg Thieme Verlag 2004. p.123.