THE ROLE OF SURGICAL MANAGEMENT OF ANTERIOR ACETABULAR WALL AND COLUMN FRACTURES THROUGH ANTERIOR APPROACHES

Dr. Rajesh K. Ambulgekar, Dr. Rohit R. Somani

Abstract


Background: Acetabulum fractures are generally occur due to high energy trauma in the young as opposed to the elderly, in whom, it can also occur due to a simple fall. Isolated anterior wall and column fractures are a fairly rare entity due to which most the studies analyze them in combination with other fractures of acetabulum, thereby distorting the actual picture. Recently the Modified Stoppa approach has come into the picture for being an excellent approach for the management of the anterior wall and column fractures of the acetabulum.

Methods: A total of 22 cases of fractures involving the anterior acetabular wall and column treated surgically with Open Reduction and internal fixation using reconstruction plates for the pelvic brim, spring plates for the quadrilateral surfaces through the anterior approaches. Patients were assessed pre-operatively and post-operatively using clinical findings, radiological and functional measures on 1st, 3rd & 5th month for first 6 months and third monthly thereafter.

Results: 14 patients had anatomical reduction, 5 had imperfect reduction and 3 had poor reduction. Out of 22 patients, 7 patients had excellent, 8 had good, 4 had fair and 3 had a poor result based on the Modified Merle d’Aubgine score. The average blood loss during the procedures in our study was 862.04 ml ± 254.65. The average surgical time was 279 minutes. There were 2 cases of superficial infection, 1 case of sciatic nerve neuropraxia with transient foot drop which recovered fully in 5 to 6 months, 3 patients developed early osteoarthritis.

Conclusion: The anterior intra pelvic approach with lateral window of ilioinguinal approach can be a good alternative to the standard ilioinguinal approach. The spring plate application to the quadrilateral surface helps in providing an excellent buttressing to this area which helps in union and establishing a good bone stock in case future surgeries are planned in this region.


Keywords


Low molecular weight heparin, DVT prophylaxis, TDS

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References


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