Summary
This is a prospective study on the medium and long-term results of the operative treatment of 74 patients with a total of 75 acetabular fractures with at least 5 mm displacement, involving at least one column in a nine years period. Plain radiographs and CT scans were used pre- and postoperatively for evaluation of the reduction of fragments. The approaches used included the Kocher-Langenbeck, ilioinguinal, and extensile iliofemoral. The patients were followed for an average of 53 months (range 28–128 months). Postoperatively the radiographic fragment reduction was excellent in 44%, good in 36%, fair in 12% and poor in 8% cases, whereas the clinical results were 32%, 38%, 15% and 15% respectively. Complications were observed in 21 patients, but only in 11 (14%) were they associated with significant clinical impairment needing additional procedures. Particularly, heterotopic ossification (24%) and subcutaneous infection (1.3%) were mostly observed after extensile exposure (p<0.001), whereas posttraumatic arthrotic changes were noted in 6 and avascular femoral head necrosis in 4 additional patients. Two transient femoral nerve pareses were observed at the beginning of the learning curve with the ilioinguinal approach. The results show that the operative treatment of displaced acetabular fractures offers the experienced trauma surgeon good medium- and long-term results, reduces the risks of long bed-rest by allowing early mobilization, and reduces the rate of early and late complications.
Résumé
Il s’agit d’une étude prospective avec des résultats à moyen et à long terme du traitement chirurgical de 74 patients ayant une fracture du cotyle avec un déplacement d’au moins 5 mm et une fracture d’au moins une colonne, étudiés pendant une période de neuf ans. Des radiographies standards et des coupes scanographiques ont été utilisés en pré- et en post-opératoire pour l’évaluation de la réduction des fragments. Les voies d’abord utilisées ont été la voie de Kocher-Langenbeck, la voie ilio-inguinale ou une voie ilio-fémorale étendue.
Les patients ont été suivis avec un recul moyen de 53 mois (extrêmes 28 et 128 mois). La réduction radiologique contrôlée en post-opératoire était excellente chez 44% des cas, bonne dans 36%, moyenne dans 12% et médiocre dans 8%; les résultats cliniques selon les mêmes qualificatifs étaient respectivement de 32%, 38%, 15% et 15%. Des complications ont eu lieu chez 21 patients mais ne nécessitèrent une reprise chirurgicale que chez 11 patients (14%).
Des ossifications hétérotopiques dans 24% des cas et des infections sous-cutanées dans 1,3%, ont été plus vues dans les abords étendus (P<0,001) alors que les arthroses posttraumatiques ont été notées dans 6 cas et une ostéonécrose aseptique de la tête fémorale dans 4 cas. Deux parésies transitoires du nerf fémoral (crural) ont compliqué des abords ilio-inguinaux pendant la phase d’apprentissage chirurgical.
En conclusion, le traitement chirurgical des fractures déplacées du cotyle donne au chirurgien traumatologue des résultats satisfaisants à moyen et à long terme, réduit les risques dus au décubitus, permet la mobilisation immédiate et diminue le taux des complications précoces et tardives.
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Korovessis, P., Stamatakis, M., Sidiropoulos, P. et al. Treatment protocol, results and complications of operative treatment of displaced acetabular fractures. Eur J Orthop Surg Traumatol 10, 99–106 (2000). https://doi.org/10.1007/BF02803104
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DOI: https://doi.org/10.1007/BF02803104