MID-TERM RESULTS OF THE CONSERVATIVE AND SURGICAL TREATMENT OF ACETABULAR FRACTURES

Abstract

Objective Experienced clinics and surgeons publish their experiences in the acetabular region where joint alignment is very important. We aimed to present the mid-term results of patients with acetabulum fractures accompanied by our clinical experience. Materials and Methods Between January 2004 and May 2013, among the 52 patients who applied to our clinic with an acetabular fracture, 37 of them met the criteria. Ten patients were treated conservatively and 27 patients with surgical treatment. The sex distribution was 28 males and 9 females. 23 of the fractures were on the right side and 14 were on the left acetabulum. Mechanism of injury, 16 (43.2%) patients were caused by traffic accidents, 13 (35.1%) patients were motor accidents, 6 patients were falling from height and 2 patients other accidents. There were other orthopedic injuries were present in 18 cases. All patients had Judet X-rays and computed tomography. Results The average follow-up period was 37 months (12- 108). Twenty-eight patients had simple fractures and 9 patients had complex fractures. There was the posterior hip dislocation of 8(21.6%) patients. After evaluation in the emergency room, all dislocated hips were reduced. There was no relation between the mechanism of injury and the type of fracture(p=0.446). Two of the surgical group and one of the conservative groups had sciatic nerve palsy after fracture (p=0.440). Twenty patients had Kocher-Langenbeck (70.9%), 3 patients Ilioinguinal (12.5%), 2 patients Triradiat (8.3%), and 2 patients (8.3%) combined incision. We used a Harris hip score for functional results. Results of score were in conservative group 6(60%) patients excellent, 2(20%) patients good, and 2 (20%) patients poor results(p=0.659). In the surgery group, we found clinical functional results excellent in 10 patients, good in 11 patients, moderate in 3 patients, and poor in 3 patients(p=0.665). Conclusion Surgical planning suitable for fracture type and anatomical reduction reveals satisfactory results in suitable and compatible patients. It should be kept in mind that anatomical reduction alone is not enough, complications such as traumatic hip dislocation, cartilage damage of the femoral head and acetabulum and sciatic nerve palsy also have a prospective effect.

Keywords

• Acetabulum fractures
• acetabulum surgery
• clinical experience
• conservative treatment
• posterior dislocation

ASETABULUM KIRIKLARINDA ORTA DÖNEM KONSERVATİF VE CERRAHİ TEDAVİ SONUÇLARIMIZ

Abstract

Amaç Deneyimli klinikler ve cerrahlar eklem uyumunun çok önemli olduğu asetabuler bölgeye dair tecrübelerini yayınlamaktadır. Biz de asetabulum kırığıyla başvuran hastaların klinik tecrübelerimiz eşliğinde orta dönem sonuçlarını sunmayı amaçladık. Gereç ve Yöntem Kliniğimize Ocak 2004-Mayıs 2013 tarihleri arasında asetabulum kırığıyla başvuran 52 hastanın, kriterleri taşıyan 37’si çalışmaya alındı. 10 hastaya konservatif, 27 hastaya cerrahi tedavi uygulandı. Cinsiyet dağılımı 28 erkek, 9 kadın şeklindeydi. Kırıkların 23’ü sağ tarafta, 14’ü sol asetabulumu içermekteydi. Oluş mekanizmalarına bakıldığında 16(%43,2) hasta araç içi trafik kazası, 13(%35,1) hasta araç dışı trafik kazası, 6 hasta yüksekten düşme ve 2 hasta da üzerine ağırlık düşmesi sonucu meydana gelmişti. 18 vakada eşlik eden diğer ortopedik yaralanmalar mevcuttu. Tüm hastalara Judet grafileri ve bilgisayarlı tomografi çekildi. Bulgular Ortalama takip süresi 37 ay(12-108)’dı. Kırıkların 28’i basit kırıklardan, 9’u kompleks kırıklardan oluşmaktaydı. 8(%21,6) hastada posterior kalça dislokasyonu bulunmaktaydı. Acilde ilk değerlendirme sonrası tüm hastaların kalçaları redükte edildi. Kırıkların oluş mekanizması ve kırık tipi arasında bir ilişki saptanmadı( p=0,456). Cerrahi uygulanan grupta 2, konservatif grupta 1 olguda kırık sonrasında oluşan siyatik hasar mevcuttu(p=0,440). 20 hastaya Kocher-Langenbeck (%70,9), 3 hastaya İlioinguinal (%12,5), 2 hastaya Triradyat (%8,3), 2 hastaya da kombine (%8,3) insizyon uygulandı. Fonksiyonel sonuçlar Harris kalça skorlamasına göre yapıldı; konservatif grupta 6(%60) hastada mükemmel, 2(%20) hastada iyi, 2(%20) hastada da kötü sonuç elde edildi(p=0,659). Cerrahi uygulanan grupta klinik fonksiyonel sonuçları 10 hastada mükemmel, 11 hastada iyi, 3 hastada orta ve 3 hastada kötü olarak saptadık(p=0,665). Sonuç Kırık tipine uygun cerrahi planlama ile anatomik redüksiyon uygun ve uyumlu hastalarda tatmin edici sonuçlar ortaya çıkartır. Yalnız anatomik redüksiyonun tek başına yeterli olmadığı, ilk gelişte dislokasyonun olması, meydana gelen femur başı ve asetabulumdaki kıkırdak hasarı ve siyatik sinir hasarı gibi komplikasyonların da prospektif etkisinin olduğu unutulmamalıdır.

Keywords

• Asetabulum kırıkları
• konservatif tedavi
• posterior dislokasyon
• asetabulum cerrahisi
• klinik deneyim

References

1. References 1. Tornetta III P. Acetabular fracture/dislocation. J Orthop Trauma 2002;16(2):139-42.
2. 2. Kınık H. Asetabulum Kırıkları. TOTBİD Dergisi 2002;2:46-59.
3. 3. Pennal, G.F, Davidson J, Garside H, Plewes J. Results of treatment of acetabular fractures. Clin Orthop Relat Res 1980;151:115-23.
4. 4. Tile M. Fractures of the acetabulum. Orthop Clin North Am 1980;11(3):481-506.
5. 5. Matta J.M, Letournel E, Browner B.D. Surgical management of acetabular fractures. Instr Course Lect 1986;35:382-97.
6. 6. Giannoudis, P.V, Grotz M.R.W, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br 2005;87(1):2-9.
7. 7. Judet R, Judet J, Letournel E. Fractures of the Acetabulum: Classification and Surgical Approaches for Open Reduction. Preliminary Report. J Bone Joint Surg Am 1964;46:1615-46.
8. 8. Olson S.A, Matta J.M. The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report). J Orthop Trauma 1993;7(5):402-13.

9. 9. Brooker A.F, Bowerman J.W, Robinson R.A, Riley L.H Jr, Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973;55(8):1629-32.
10. 10. John H, Harris Jr, Jody S, Kevin J.C, Thea T. Acetabular fractures revisited: part 1, redefinition of the Letournel anterior column. AJR Am J Roentgenol 2004;182(6):1363-6.
11. 11. D'Aubigne M, Ramadier J.O, Arthroplasty in coxarthrias. Gaz Med Fr 1951;58(7):405-15.
12. 12. Elmali N, Ertem K, Inan M, Ayan I, Denizhan Y. Clinical and radiologic results of surgically-treated acetabular fractures. Acta Orthop Traumatol Turc 2003;37(2):97-101.
13. 13. Tipton W.W, D'Ambrosia R.D, Ryle G.P. Non-operative management of central fracture-dislocations of the hip. J Bone Joint Surg Am 1975;57(7):888-93.
14. 14. Hesp W.L, Goris R.J. Conservative treatment of fractures of the acetabulum. Results after longtime follow-up. Acta Chir Belg 1988;88(1):27-32.
15. 15. Letournel E, Acetabulum fractures: classification and management. Clin Orthop Relat Res 1980;151:81-106.
16. 16. Borrelli Jr.J, Goldfarb C, Ricci W, Wagner J.M, Engsberg J.R. Functional outcome after isolated acetabular fractures. J Orthop Trauma 2002;16(2):73-81.
17. 17. Kang C.S, Min B.W. Cable fixation in displaced fractures of the acetabulum: 21 patients followed for 2-8 years. Acta Orthop Scand 2002;73(6):619-24.
18. 18. Ward A.J, Chesser T.J. The role of acute total hip arthroplasty in the treatment of acetabular fractures. Injury 2010;41(8):777-9.
19. 19. Pagenkopf E, Grose A, Partal G, Helfet D.L. Acetabular fractures in the elderly: treatment recommendations. HSS Journal 2006;2(2):161-71.
20. 20. Morison Z, Moojen D.J.F, Nauth A, Hall J, McKee M.D, Waddell J.P, Schemitsch E.H. Total Hip Arthroplasty After Acetabular Fracture Is Associated With Lower Survivorship and More Complications. Clin Orthop Relat Res 2016;474(2):392-8.
21. 21. Herscovici Jr.D, Lindvall E, Bolhofner B, Scaduto J.M. The combined hip procedure: open reduction internal fixation combined with total hip arthroplasty for the management of acetabular fractures in the elderly. J Orthop Trauma 2010;24(5):291-6.
22. 22. Kacra B.K, Arazi M, Cicekcibasi A.E, Büyükmumcu M, Demirci, S. Modified medial Stoppa approach for acetabular fractures: an anatomic study. J Trauma 2011;71(5):1340-4.
23. 23. Keel M.J.B, Ecker T.M, Cullmann J.L, Bergmann M, Bonel H.M, Büchler L. et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg Br 2012;94(3):405-11.
24. 24. Okur A, Karsan O, Alparslan B, Ezirmik N, Kör A. Asetabulum kırıklarında tedavi sonuçlarımız. Atatürk Üniversitesi Tıp Dergisi 1996;28:169-73.
25. 25. Erdoğan F, Poursani R.S, Öğüt T, Tenekecioğlu Y. Asetabulum kırıklarında konservatif ve cerrahi sonuçlarımız. Acta Orthop Traumatol Turc. 1998;32:111-5.
26. 26. Ma K, Luan F, Wang X, Ao Y, Liang Y, Fang Y, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics 2013;36(10):e1307-15.
27. 27. Tannast M, Najibi S, Matta J.M. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am 2012;94(17):1559-67.