Arthroscopic reduction and fixation of partial posterior wall acetabular fractures

Main Article Content

Alessandro Aprato
Adell Sallam
Paolo Di Benedetto
Stefano Giaretta
Alessandro Massè

Keywords

acetabular fracture, hip arthroscopy, posterior wall fracture, hip arthroscopy portals, hip dislocation

Abstract

Background and aim: Reduction and fixation of partial posterior wall fracture is usually performed with an open posterolateral approach. When the fragment may be fixed without a plate (with screws only), reduction and fixation may be also achieved via hip arthroscopy. To our knowledge no study described this technique. Aim of our study is to describe the surgical technique and to present the achieved outcomes and the occurred complications.


Methods: Six cases of arthroscopic fixation of partial posterior wall fracture have been reviewed for the purpose of this study. Patients were treated arthroscopically if the fragment was not bigger than 25% of the posterior wall. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta’s criteria on postoperative radiographs and clinical outcomes were evaluated with the modified Harris hip score.


Results: Fracture reduction was classified as anatomic on post-operative x-rays in all patients. The mean clinical score was 98 points at one year follow-up. No patient developed symptomatic femoral head AVN, none had heterotopic ossification. In one patients a screw breakage occurred without clinical complications.


Conclusions: Arthroscopic reduction and fixation of partial posterior wall fracture is an effective treatment and showed good outcomes if a careful patients’ selection is done.

Downloads

Download data is not yet available.
Abstract 73 | PDF Downloads 19

References

(1) Baumgaertner MR. Fractures of the posterior wall of the acetabulum. J Am Acad Orthop Surg, 1999, 7: 54–65.
(2) Yamamoto Y, Ide T, Ono T, Hamada Y. Usefulness of arthroscopic surgery in hip trauma cases. Arthroscopy. 2003 Mar;19(3):269-73.
(3) Magu NK, Rohilla R, Arora S. Conservatively treated acetabular fractures: A retrospective analysis. Indian J Orthop. 2012 ;46(1):36-45.
(4) Kaempffe FA, Bone LB, Border JR. Open reduction and internal fixation of acetabular fractures: heterotopic ossification and other complications of treatment. J Orthop Trauma. 1991;5:439-45.
(5) Yang JH, Chouhan DK, Oh KJ. Percutaneous screw fixation of acetabular fractures: applicability of hip arthroscopy. Arthroscopy. 2010;26:1556-61.
(6) Shi RM, Yuan LB, Tan CJ, Li AX, Qiu X, Yang B, Tan HB. Hip Arthroscopic Reduction and Fixation for Adolescent Acetabular Posterior Wall Fracture: A Case Report. Orthop Surg. 2021 Aug;13(6):1934-1938.
(7) Chan YS, Chiu CH, Lo YP, Chen AC, Hsu KY, Wang CJ, Chen WJ. Arthroscopy-assisted surgery for tibial plateau fractures: 2- to 10-year follow-up results. Arthroscopy. 2008 Jul;24(7):760-8.
(8) Ono A, Nishikawa S, Nagao A, Irie T, Sasaki M, Kouno T. Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes. Arthroscopy. 2004 Jul;20(6):627-31
(9) Jamil M, Dandachli W, Noordin S, Witt J. Hip arthroscopy: indications, outcomes and complications. Int J Surg, 2018, 54: 341–344
(10) Larson CM, Swaringen J, Morrison G. A review of hip arthroscopy and its role in the management of adult hip pain. Iowa Orthop J 2005;25:172-179.
(11) Niroopan G, De Sa D, MacDonald A, Burrow S, Larson CM, Ayeni OR: Hip arthroscopy in trauma: a systematic review of indications, efficacy, and complications. Arthroscopy. 2016, 32(4):692-703.
(12) Aprato A, Buzzone M, Di Benedetto P, Massè A. Surgical hip dislocation vs arthroscopy for fixation of subfoveal femoral head fractures: A new technique for Pipkin type 1 fractures. Acta Biomed. 2021 Jul 26;92(S3):e2021016.
(13) Khanna V, Harris A, Farrokhyar F, Choudur HN, Wong IH: Hip arthroscopy: prevalence of intra-articular pathologic findings after traumatic injury of the hip. Arthroscopy. 2014, 30:299-304.
(14) Zhong M, Xie H, Fu Z, Lu W, Zhu W, Ouyang K. Arthroscopic Treatment of Acetabular Rim Fracture after Traumatic Posterior Hip Dislocation: A Case Series Study. Orthop Surg. 2021;13(6):1828-1834.
(15) Aprato A, Nardi M, Arduini M, Bove F, Branca Vergano L, Capitani D, Casiraghi A, Cavanna M, Cominetti G, Commessatti M, Favuto M, Ferreli A, Fino A, Gulli S, Lamponi F, Massè A, Mezzadri U, Monesi M, Oransky M, Pannella A, Santolini F, Stella M, Tigani D, Zoccola K, Rocca G. Italian Consensus Conference on Guidelines for preoperative treatment in acetabular fractures. Acta Biomed. 2021 Sep 2;92(4):e2021290.
(16) Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78:1632–1645
(17) Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;119:39-47
(18) Aprato A, Jayasekera N, Villar RN. Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy? Am J Sports Med. 2012 Nov;40(11):2557-60.
(19) Brooker A, Bowerman J, Robinson R, Riley LH. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1955;55:1629–1632
(20) Aprato A, Giachino M, Masse A. Arthroscopic approach and anatomy of the hip. Muscles Ligaments Tendons J. 2016 Dec 21;6(3):309-316.
(21) Stabile KJ, Neumann JA, Mannava S, Howse EA, Stubbs AJ. Arthroscopic treatment of bucket-handle labral tear and acetabular fracture. Arthrosc Tech, 2014, 3:e283–e287.
(22) Foulk DM, Mullis BH. Hip dislocation: evaluation and management. J Am Acad Orthop Surg, 2010, 18: 199–209.
(23) Mandell JC, Marshall RA, Banffy MB, Khurana B, Weaver MJ. Arthroscopy after traumatic hip dislocation: a systematic review of intra-articular findings, correlation with magnetic resonance imaging and computed tomography, treatments, and outcomes. Arthroscopy, 2018, 34: 917–927.
(24) Park MS, Yoon SJ, Choi SM. Hip arthroscopic management for femoral head fractures and posterior acetabular wall fractures (Pipkin type IV). Arthrosc Tech, 2013, 2: e221–e225.
(25) Morris AC, Yu JC, Gilbert SR. Arthroscopic treatment of traumatic hip dislocations in children and adolescents: a preliminary study. J Pediatr Orthop, 2017, 37: 435–439.

Most read articles by the same author(s)

1 2 3 4 5 6 > >>