Mid-term results of displaced acetabulum fractures surgically treated using anterior intra-pelvic approach (modified Stoppa)

BACKGROUND: This study aims to evaluate the radiological and clinical mid-term results of the patients with displaced acetabular fractures surgically treated with open reduction and internal fixation using an anterior intra-pelvic approach (AIP).
METHODS: In this study, we retrospectively reviewed 12 patients with displaced acetabular fractures treated surgically via the AIP approach. Patients were analyzed for Letournel’s acetabular fracture classification, associated injuries, time to surgery, additional surgical procedures needed, perioperative and postoperative complications, radiologic and functional results.
RESULTS: Of the 12 patients, the male/female ratio was 1/2; the mean age was 40.5±16.2 (16–64) years. The mean follow-up time was 59.8±32.2 (12–124) months. Seven patients had both column fractures, three patients had anterior column + posterior hemitransverse fractures, one patient had transverse + posterior wall and one patient had anterior column fracture. The mean time to surgery was 6.6±4.4 (2–16) days. The mean intraoperative blood transfusion was 830 (300–2000) ml. Intra-operative and post-operative complications were noted in eight patients. The mean Merle d’Aubigné and Postel score was 14.5±2.7 (10–18). Six patients with an anatomical reduction of the fracture showed excellent/good functional and radiologic outcomes. Three patients with a non-anatomic reduction developed post-traumatic arthrosis that was treated with total hip arthroplasty.
CONCLUSION: AIP approach provides a satisfactory exposure for the surgical treatment of displaced anterior wall/column and both column acetabular fractures. Clinical outcome is directly related to the reduction quality. Patients with poor reduction are most likely to develop mid-term complications, such as hip joint arthrosis.

Anteriyor intra-pelvik yaklaþýmla (modifiye Stoppa) tedavi edilen deplase asetabulum kýrýklarýnýn orta dönem sonuçlarý

AMAÇ: Bu çalýþmanýn amacý deplase asetubulum kýrýklarýnýn cerrahi tedavisinde anteriyor-intra pelvik (AÝP) yaklaþýmla açýk redüksiyon ve içten tespitin etkinliðini, orta dönem klinik ve radyolojik sonuçlarýný ortaya koymaktýr.
GEREÇ VE YÖNTEM: Deplase asetabulum kýrýðý tanýsýyla baþvuran hastalardan AÝP yaklaþým ile açýk yerleþtirme ve içten tespit uygulanan 12 hasta geriye dönük olarak incelendi. Hastalar, kýrýk tipi, ek yaralanma varlýðý, ameliyata kadar geçen süre, ek cerrahi giriþim ihtiyacý, perioperatif komplikasyonlar, radyografik ve fonksiyonel sonuçlar açýsýndan deðerlendirildi.
BULGULAR: Erkek/kadýn oraný 1/2 idi. Ortalama yaþ 40.5±16.2 (16-64) yýldý. Ortalama takip süresi 59.8±32.2 (12–124) aydý. Yedi hastada çift kolon, üç hastada anteriyor kolon+posteriyor hemitransvers, bir hastada transvers+posterior duvar ve bir hastada anteriyor kolon kýrýk paterni mevcuttu. Hastalar, ortalama 6.6±4.4’üncü (2–16) günde ameliyat edildi. Amaliyat sýrasýnda kan transfüzyonu ortalama 830 (300–2000) mL idi. Sekiz hastada ameliyatta ve ameliyat sonrasý komplikasyonlar gözlemlendi. Ortalama Merle d’Aubigné and Postel skoru 14.5±2.7 (10–18) idi. Anatomik redüksiyon elde edilen altý olguda mükemmel/iyi fonksiyonel ve radyolojik sonuç gözlemlendi. Anatomik olmayan redüksiyon elde edilen üç hastada orta dönemde post-travmatik kalça artrozu geliþti ve total kalça replasmaný ile tedavi edildi.
TARTIÞMA: AÝP yaklaþým, asetabulumun deplase anteriyor duvar/kolon ve özellikle çift kolon kýrýklarýnýn cerrahi tedavisinde yeterli açýlýmý saðlar. Klinik sonuçlar, redüksiyon kalitesiyle doðrudan iliþkilidir. Anatomik olmayan redüksiyon elde edilen hastalarda orta-dönemde kalça eklem artrozu açýsýndan dikkatli olunmalýdýr.