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Surgical Dislocation Technique for the Treatment of Acetabular Fractures

Abstract

Background

Surgical hip dislocation allows for a 360° view of the acetabulum and may facilitate a reduction in selected acetabular fractures. To our knowledge there is no description in the literature of the different techniques used to reduce acetabular fractures through this approach. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification.

Description of Technique

The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. T-type, transverse fractures alone or associated with posterior wall could be reduced with specific clamps and reduction adequacy can be judged by direct view. Anterior column fixation could be performed with one or two screws; the posterior column could be fixed with a single posterior plate or with two plates if a transverse fracture is associated with a posterior wall fracture.

Methods

Between 2005 and 2011, we used this approach selectively to manage those types of fractures; during the period in question, we treated 312 acetabular fractures surgically, of which 31 (10%) were treated using this approach. Patient demographic, injury, and surgical variables as well as complications were recorded. Outcomes were evaluated with the Merle d’Aubigné and Postel system. Radiographic outcome was scored according to Matta’s criteria on postoperative radiographs (AP and Judet views). Minimum followup was 24 months (mean, 43 months; range, 24–87 months).

Results

Fracture reduction was defined as anatomic in 65% cases, imperfect in 16%, and poor in 19%. Mean Merle d’Aubigné score was 15 points (out of 18, with higher scores being better). Two patients developed symptomatic femoral head avascular necrosis.

Conclusions

In complex cases, surgical dislocation presents several advantages; a single approach may reduce surgical time, permit direct intraarticular assessment, and facilitate screw placement closer to the articular surface. It also presents several limitations; some difficulties with bone-reduction clamp positioning, limited fixation of the anterior column, and a small risk of greater trochanter malunion.

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Acknowledgments

We acknowledge the important assistance of Gianluca Amadore, IT administrator, for radiographic information technology support. We would like to thank Dr. Marco M. Favuto for his help with the revision of the discussion session.

Author information

Correspondence to Alessandro Aprato MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed in the Orthopaedic Department, San Luigi Hospital of Orbassano, University of Turin, Turin, Italy.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1 The different techniques for the reduction of fractures through the surgical dislocation technique are shown. (WMV 339487 kb)

Video 2 Reduction of a transverse fracture is commonly performed by pushing the inferior part of the pelvic brim outward and downward. (AVI 39548 kb)

Supplementary material (DOC 22 kb)

Video 1 The different techniques for the reduction of fractures through the surgical dislocation technique are shown. (WMV 339487 kb)

Video 2 Reduction of a transverse fracture is commonly performed by pushing the inferior part of the pelvic brim outward and downward. (AVI 39548 kb)

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Masse, A., Aprato, A., Rollero, L. et al. Surgical Dislocation Technique for the Treatment of Acetabular Fractures. Clin Orthop Relat Res 471, 4056–4064 (2013). https://doi.org/10.1007/s11999-013-3228-8

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Keywords

  • Femoral Head
  • Heterotopic Ossification
  • Acetabular Fracture
  • Anterior Column
  • Transverse Fracture