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Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objectives

To assess the efficacy and safety of digastric trochanteric flip osteotomy technique in the management of acetabular fractures and to evaluate surgical outcome in terms of fracture reduction, femoral head viability of selected acetabular fractures treated operatively using a digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with surgical dislocation of the femoral head.

Design

Prospective.

Patients

Eighteen patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures.

Outcome evaluation

Clinical and radiographic analysis after a minimum 18 months follow-up.

Methods

A single modified approach involving digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with anterior (n = 14) or posterior (n = 4) surgical dislocation of the femoral head, was done for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement.

Results

At a mean follow-up of 26 months (18–40 months), the 17 patients presented with a good to excellent clinical result according to the d’Aubigné score. In all subjects, anatomical reduction was achieved during surgery. The osteotomy site healed at an average of 7 weeks and all the patients recovered abductor strength at 12 weeks. One avascular necrosis occurred in a case of posterior column plus wall fracture (who presented to us after 3 weeks). No heterotopic ossification interfering with hip function was found.

Conclusion

This technique gives good exposure (especially in posterior wall, dome area, posterior fracture-dislocation with intra-articular fragments/femoral head fractures and T-fractures), preservation of abductor strength (which may be lost with excessive retraction of abductors to see dome area in classical posterior approach), reliable healing of osteotomy (in contrast to conventional trochanteric osteotomy) without risking the vascularity of femoral head.

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Author notes

  1. Prasoon Shamshery

    Present address: Sahara Hospital, Lucknow, India

  2. Vikas Gupta

    Present address: Fortis Hospital, New Delhi, India

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Sameer Naranje, Prasoon Shamshery, C. S. Yadav, Vikas Gupta & H. L. Nag

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  1. Sameer Naranje
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  2. Prasoon Shamshery
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  3. C. S. Yadav
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Correspondence to Sameer Naranje.

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Naranje, S., Shamshery, P., Yadav, C.S. et al. Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures. Arch Orthop Trauma Surg 130, 93–101 (2010). https://doi.org/10.1007/s00402-009-0873-1

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