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Less Invasive Surgeries in the Management of Acetabular Fractures in Adults Abstract

Acetabular fractures are rapidly increasing in the present scenario of the practice of orthopedic surgery due to ever increasing high velocity injuries especially the road traffic accidents (RTAs). Acetabular fractures still are among the most challenging fractures to treat because of complex three dimensional anatomy, involved surgical access to fracture sites and the siginificant risk of neurovascular and visceral injuries. The aim of this study as to evaluate the clinical and radiological results of patients presented by fracture acetabulum and treated by less invasive methods of reduction and fixations. !The study included "# patients ith i th acetabular fractures all operated at Tanta $niversity %ospital. The age of patients ranged from &# to ' years ith an average of.* years. There ere * males and & females. The right side as affected in &+ patients hile left side as affected in + patients. The causative injury as motor vehicle accidents in " patients, motor cycle in & patients, pedestrian in  patients and falling from height in " patients. The fractures ere classified according to letoumel &++ (-).

Surgical treatment of complex Acetabular fractures Abstract

Acetabular fractures are not uncommon injuries in gypt. The aim of surgical treatment is to preserve hip mobility and to avoid of post/ traumatic arthritis. Any factor that interfere ith this goal may jeopardi0e the function of the hip  The aim of this study as to to evaluate the clinical and radiological results of patients presented by displaced complex acetabular fractures and treated by open reduction and internal fixation.  The study included '' patients ith complex acetabular fractures. 1nitial assessment and treatment as directed toards the patient!s general condition .2osterior hip dislocation as reduced as fast as possible. 3tandard x/ray vies and 4T cuts as done for every patient to classify the fracture and to define its personality. The definite surgery as done through an ilioinguinal, a 5ocher /6angenbeck or combined approaches. 2ostoperatively, the residual displacement as recorded together ith the head roof relationship. $sing 7atta radiological grades and his modified clinical grading a correlation beteen radiological and clinical results as made. 8actors affecting the outcome ere defined.  The mean follo/up period as +.* 9.&+ months ith ith a minimum of & months and a maximum of " months. xcellent to good results ere achieved in (# case : *#.&;), hile fair to poor results ere the end result in (& case : -.+;).

 

Anatomical reduction and <or restoration of perfect head<roof congruency ere strongly associated ith better outcome. =eside this there as significant relation beteen good clinical outcome and the utili0ation of the anterior approach. >n the other hand bad outcome as associated ith these factors (&) associated pelvic ring injury.()posterior all involvement .() articular surface comminution (") intra/articular fragments.

Surgical Treatment of Acetabular Fractures Acetabular fractures represent an injury to the articular surface of a major eight bearing joint and should be treated in according ith the same criteria used for other intraarticular fractures.  The surgical management of displaced acetabular fractures is indicated indicated for an unstable and an incongruous hip joint.  The acetabulum is formed by to columns of bone, bone, anterior and posterior.  These columns converge and meet in a thick thick and compact portion of bone situated infront of and belo the iliac reticular surface of the sacroiliac  joint.  The majority of patients ith acetabular fractures have have been involved in a motor vehicle accident, either in a car or on a motorcycle.  ?udet and 6etournel, divided acetabular acetabular fracture into to major types, elementary and associated or complex@ each has its subgroup. They considered the acetabulum to be an arch formed by to columns of bone, one anterior and the other is posterior.  The most definitive indication for surgery is instability of the hip joint.  The type of fracture mainly determines the choice of incision, incision, but other factors also influence the choice. The general trend is toards more limited exposures to avoid the complications of the more extensile ones. isplaced acetabular fractures are usually associated ith significant morbidity and mortality. &+ 3ummary A number of the complications, hoever, are secondary to surgical treatment@ including either immediate post/surgical complications such as infection, nerve injuries thromboembolism and malreduction, and late complications such as heterotopic ossification, avascular necrosis of the femoral head or acetabular fracture fragment, posttraumatic osteoarthritis and implant failure.  The aim of this ork is to assess assess the results of surgical treatment of fractures of the acetabulum. from ?anuary -- to 7arch --', thirty patients ith displaced acetabular fractures ere treated by open reduction and internal fixation in >rthopaedic department, 8aculty of 7edicine, 7e dicine, 7enoufiya $niversity.  The average patient age at time of acetabular fracture surgery as  years, ith a range of &# to ''years. All ere ambulatory at the time of injury. There ere * male patients and " females. The right side as affected in &" patients and the left side in &* patients.

 

 The mechanisms of the injury ere a traffic accident for " patients (dashboard injuries and " pedestrian injuries) and a fall for * patients.  The follo up period ranges from telve months to * months. =ased on the ?udet and 6etournel classification, there ere fourteen elemental patterns (six posterior all, three posterior column and five transverse) and sixteen associated fractures (five T/type, six both column, three T/shaped B posterior all and to transverse B posterior all). 3ix patients sustained a fracture ith dislocation@ five posterior central. Co cases ith anterior di slocation. dislocation. >ne patient had a and one &+# 3ummary fracture of the femoral head (2ipkin type 1D). The follo up period ranges from telve months to * months. 3even cases of near perfect reduction (.;), sixteen cases ith good reduction ('.";) and seven cases ith poor reduction (.;). All cases ere evaluated radiologically and functionally. Radiological evaluation includes early and late radiological evaluation. arly radiological results ere seven cases of near perfect reduction (.;), sixteen cases ith good reduction ('.";) and seven cases ith poor reduction (.;). 6ate radiological results ere excellent in four cases (&.;), good in fifteen cases ('-;), fair f air in five cases (&*.;) and poor in six cases (-;). 8unctional results ere excellent in four cases (&.), good in fourteen cases ("*.;), fair in six cases (-;) and poor in another six cases (-;). 1ntraarticular fragments and acetabular impaction ere found in four cases.  To ('-;) cases gave good results results hile the other to ('-;) gave fair and poor results. The difference beteen patients ho had intraarticular fragments and acetabular impaction and those ithout these findings as found to be significant. 5ocher/6angenbeck appeared the most popular approach used in acetabular fractures treatment as it as used in seventeen cases ('*.;).  Transtrochanteric approach as used in ten ten cases (.;), 4ombined approach in to cases (*.;) and xtensile Triradiate approach in only one case (.;).  Tenty/four (#-;) cases ere fixed ith reconstruction reconstruction plates hile six (-;) cases ere fixed ith scres alone. &++ 3ummary  The average length of hospitali0ation as &. &. days, ranged from ' to "' days. The mean as -.' days. arly complications included, deep venous thrombosis in three cases (&-;), to cases (*.;) developed sciatic nerve injury, failure of fixation occurred in to cases (*.;) and infection in three cases (&-;). 6ate complications included, heterotopic ossification in to cases (*.;), osteoarthritis occurred in femoral three cases (&-;), to cases (*.;) developed avascular necrosis of the head.

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