Management and Outcomes of Displaced Fractures of the Acetabulum

Öz

Background: Surgical management of displaced acetabular fractures represents a challenge for orthopedic surgeons due to their biomechanical complexity. An open reduction with anatomical correction can provide good to excellent clinical results for these patients. However, this depends on several determinants, such as the center experience, surgical approach, patient age, and fracture mechanism. The purpose of this study was to evaluate the anatomical, radiologic and functional results of the acetabular fracture treatments in a level 1 trauma center of a university hospital. Materials and Methods: This single-center retrospective clinical study was conducted between January 2011 and June 2015 at Harran University Medical School, Department of orthopedics, and traumatology. Patients who presented to the emer-gency department with acetabular fractures and managed surgically were included in the study. Demographic variables, mechanisms of injury, surgical approach, complications, radiographic and functional outcomes were recorded from patient charts. Anatomical results were examined on standard x rays of the pelvis and Judet`s oblique radiographs. Clinical results were analyzed according to the Postel-Merle d'Aubigne criteria. Results: Forty-eight patients presented to our emergency department with acetabular fractures. Seventeen of these patients were treated surgically, whereas 31 were managed conservatively. The most common type of injury was motor vehicle accidents. In the surgical reduction of these fractures, mostly the Kocher-Langenbeck approach was preferred by the surgeons. The mean follow-up of patients was mean 4.2 years. According to Matta's criteria, the reduction was consid-ered anatomical in 5 patients, acceptable in 10 patients, and poor in 2 patients. During the last postoperative follow-up of these patients, eight were evaluated as excellent, four good, two fair, and three poor according to Matta`s radiologic crite-ria. Overall, twelve patients in the study cohort presented good or excellent clinical and functional results (70.5%). Conclusions: This study adds additional data to the growing body of clinical research and validates open reduction as the treatment of choice in selected high energy injuries of the acetabulum. Additionally, in the long-term follow-up, this strategy has shown satisfactory clinical and functional results.

Anahtar Kelimeler

• Acetabulum fracture
• Kocher Langenback
• Pelvis fracture

Deplase Asetabulum Kırıklarının Yönetimi ve Klinik Sonuçları

Öz

Amaç: Yer değiştirmiş asetabular kırıkların cerrahi yönetimi, biyomekanik karmaşıklıkları nedeniyle ortopedik cerrahlar için bir zorluk teşkil etmektedir. Anatomik düzeltme ile açık redüksiyon bu hastalar için iyi ila mükemmel klinik sonuçlar sağla-yabilir. Ancak, bu durum merkez deneyimi, cerrahi yaklaşım, hasta yaşı ve kırık mekanizması gibi çeşitli belirleyicilere bağlıdır. Bu çalışmanın amacı, bir üniversite hastanesinin 1. seviye travma merkezinde asetabulum kırığı tedavilerinin anatomik, radyolojik ve fonksiyonel sonuçlarını değerlendirmektir. Materyal ve Metod: Bu tek merkezli retrospektif klinik çalışma Ocak 2011 ile Haziran 2015 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı'nda gerçekleştirildi. Acil servise asetabulum kırığı ile başvuran ve cerrahi olarak tedavi edilen 48 hasta çalışmaya dahil edildi. Demografik değişkenler, yaralanma mekanizmala-rı, cerrahi yaklaşım, komplikasyonlar, radyografik ve fonksiyonel sonuçlar hasta dosyalarından kaydedildi. Anatomik sonuçlar standart pelvis grafileri ve Judet'in oblik grafileri ile incelendi. Klinik sonuçlar Postel-Merle d'Aubigne kriterlerine göre analiz edildi. Bulgular: Araştırmaya dahil edilen 48 hasta acil servisimize asetabulum kırığı ile başvurdu. Bu hastaların 17'si cerrahi olarak tedavi edilirken, 31'i konservatif olarak tedavi edildi. En sık görülen yaralanma tipi motorlu araç kazalarıydı. Bu kırıkların cerrahi redüksiyonunda cerrahlar tarafından çoğunlukla Kocher-Langenbeck yaklaşımı tercih edildi. Hastaların ortalama takip süresi 4,2 yıldı. Matta'nın kriterlerine göre redüksiyon 5 hastada anatomik, 10 hastada kabul edilebilir ve 2 hastada kötü olarak değerlendirildi. Bu hastaların ameliyat sonrası son takiplerinde Matta'nın radyolojik kriterlerine göre sekizi mükemmel, dördü iyi, ikisi orta ve üçü kötü olarak değerlendirildi. Genel olarak, çalışma kohortundaki on iki hasta iyi veya mükemmel klinik ve fonksiyonel sonuçlar sundu (%70,5). Sonuç: Bu çalışma, artan klinik araştırmalara ek veriler eklemekte ve asetabulumun seçilmiş yüksek enerjili yaralanmala-rında tercih edilen tedavi olarak açık redüksiyonu doğrulamaktadır. Ayrıca, uzun dönem takipte, bu strateji tatmin edici klinik ve fonksiyonel sonuçlar göstermiştir.

Anahtar Kelimeler

• Asetabulum kırığı
• Kocher Langenback
• Pelvis kırığı

Kaynakça

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