Skip to main content
SpringerLink
Log in

Clinical results of acetabular fracture treatment with hybrid fixation by anterior and posterior approach

A minimally invasive technique

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

Open reduction and internal fixation have been described as the gold standard for the treatment of acetabular fractures, but the high complications of these surgeries have led surgeons to seek less invasive procedures. In recent years, minimally invasive treatment, such as fixation through the skin have been proposed. The aim was to assess acetabular fracture outcomes of combination of posterior approach (Kocher-Langenbeck [KL]) with anterior percutaneous screw fixation (APSF) with minimally invasive surgery (MIS).

Methods

Between February 2017 and July 2019, 155 patients with acetabular fractures underwent fixation with the KL + APSF approach. For 1 year functional outcomes, radiographic findings, and postoperative complications were evaluated.

Results

Of 155 patients with a mean age of 40.16 ± 10.32 years, 82 patients were male and 73 were female. The most common pattern of fracture was both columns (32.9%). The average blood loss was approximately 527 ml. The average operation time was 85 min. The mean length of surgical incision was 113.3 mm. Harris’ hip score was excellent in 75.5% of cases. The mean VAS score was approximately 4 and 91.6% of patients returned to pre-trauma activity. In 74.8% of cases, the reduction was anatomical. Complications after surgery were very insignificant and included the following: 2 patients had foot drop within 5 months both patients recovered, 2 patients had femoral nerve palsy and 3 cases of deep vein thrombosis and 1 case of pulmonary thromboembolism were treated. There were four patients with surgical site infections, all of whom recovered and two of the seven patients with osteoarthritis underwent total hip arthroplasty.

Conclusion

Combining posterior approach with minimally invasive anterior method in fixation and treatment of acetabular fractures is a safe and reliable method and showed significant functional results with minimal complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Briffa N, Pearce R, Hill A, Bircher M. Outcomes of acetabular fracture fixation with ten years’ follow-up. J Bone Joint Surg Br. 2011;93(2):229–36.

    Article  CAS  PubMed  Google Scholar 

  2. Zhao JX, Zhang LC, Su XY, Zhao Z, Zhao YP, Sun GF, Zhang LH, Tang PF. Early experience with reduction of unstable pelvic fracture using a computer-aided reduction frame. BioMed Research International. 2018. https://doi.org/10.1155/2018/7297635.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yoshihara H, Yoneoka D. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. J Trauma Acute Care Surg. 2014;76(2):380–5.

    Article  PubMed  Google Scholar 

  4. Pfeifer R, Tarkin IS, Rocos B, Pape H‑C. Patterns of mortality and causes of death in polytrauma patients—has anything changed? Injury. 2009;40(9):907–11.

    Article  PubMed  Google Scholar 

  5. Gupta RK, Singh H, Dev B, Kansay R, Gupta P, Garg S. Results of operative treatment of acetabular fractures from the Third World—how local factors affect the outcome. Int Orthop. 2009;33(2):347–52.

    Article  PubMed  Google Scholar 

  6. Magu NK, Rohilla R, Arora S. Conservatively treated acetabular fractures: A retrospective analysis. IJOO. 2012;46:36–45.

    Article  Google Scholar 

  7. Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches. J Bone Joint Surg Am. 1964;46(A:1615–46.

    Article  Google Scholar 

  8. Routt M Jr, Swiontkowski M. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg Am. 1990;72(6):897–904.

    Article  PubMed  Google Scholar 

  9. Harris AM, Althausen P, Kellam JF, Bosse MJ. Simultaneous anterior and posterior approaches for complex acetabular fractures. J Orthop Trauma. 2008;22(7):494–7.

    Article  PubMed  Google Scholar 

  10. Assal M, Ray A, Fasel JH, Stern R. A modified posteromedial approach combined with extensile anterior for the treatment of complex tibial pilon fractures (AO/OTA 43-C). J Orthop Trauma. 2014;28(6):e138–e45.

    Article  PubMed  Google Scholar 

  11. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective. Clin Orthop Relat Res. 1994;305:10–9.

    Article  Google Scholar 

  12. Kloen P, Siebenrock KA, Ganz R. Modification of the ilioinguinal approach. J Orthop Trauma. 2002;16(8):586–93.

    Article  CAS  PubMed  Google Scholar 

  13. Helfet D, Schmeling G. Management of complex acetabular fractures through single nonextensile exposures. Clin Orthop Relat Res. 1994;305:58–68.

    Article  Google Scholar 

  14. Routt MC Jr, Meier MC, Kregor PJ, Mayo KA. Percutaneous iliosacral screws with the patient supine technique. Oper Tech Orthop. 1993;3(1):35–45.

    Article  Google Scholar 

  15. Lin Y‑C, Chen C‑H, Huang H‑T, Chen J‑C, Huang P‑J, Hung S‑H, et al. Percutaneous antegrade screwing for anterior column fracture of acetabulum with fluoroscopic-based computerized navigation. Arch Orthop Trauma Surg. 2008;128(2):223–6.

    Article  PubMed  Google Scholar 

  16. Caviglia H, Mejail A, Landro ME, Vatani N. Percutaneous fixation of acetabular fractures. Efort Open Rev. 2018;3(5:326–34.

    Article  Google Scholar 

  17. Chui KH, Chan CCD, Ip KC, Lee KB, Li W. Three-dimensional navigation-guided percutaneous screw fixation for nondisplaced and displaced pelvi-acetabular fractures in a major trauma centre. International Orthopaedics (SICOT). 2018;42(6):1387–95.

    Article  Google Scholar 

  18. Mouhsine E, Garofalo R, Borens O, Wettstein M, Blanc C‑H, Fischer J‑F, et al. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury. 2005;36(11):1330–6.

    Article  CAS  PubMed  Google Scholar 

  19. Gary JL, VanHal M, Gibbons SD, Reinert CM, Starr AJ. Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation. J Orthop Trauma. 2012;26(5):278–83.

    Article  PubMed  Google Scholar 

  20. Attias N, Lindsey R, Starr A, Borer D, Bridges K, Hipp J. The use of a virtual three-dimensional model to evaluate the intraosseous space available for percutaneous screw fixation of acetabular fractures. J Bone Joint Surg Br. 2005;87(11):1520–3.

    Article  CAS  PubMed  Google Scholar 

  21. Shahulhameed A, Roberts CS, Pomeroy CL, Acland RD, Giannoudis PV. Mapping the columns of the acetabulum—implications for percutaneous fixation. Injury. 2010;41(4):339–42.

    Article  PubMed  Google Scholar 

  22. Chen KN, Wang G, Cao LG, Zhang MC. Differences of percutaneous retrograde screw fixation of anterior column acetabular fractures between male and female: a study of 164 virtual three-dimensional models. Injury. 2009;40(10):1067–72.

    Article  PubMed  Google Scholar 

  23. Puchwein P, Enninghorst N, Sisak K, Ortner T, Schildhauer TA, Balogh ZJ, et al. Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion. Arch Orthop Trauma Surg. 2012;132(6):805–11.

    Article  PubMed  Google Scholar 

  24. Letournel E. Acetabulum fractures: classification and management. Orthop Trauma Dir. 2007;5(05):27–33.

    Article  Google Scholar 

  25. McCormack HM, Jd Sheather DLS. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18(4):1007–19.

    Article  CAS  PubMed  Google Scholar 

  26. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. JBJS. 1996;78(11):1632–45.

    Article  CAS  Google Scholar 

  27. Banaszkiewicz PA. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. Classic Papers in Orthopaedics. Springer; 2014. pp. 13–7.

    Google Scholar 

  28. Ernstberger H, Pieroh P, Höch A, Josten C, Herath SC, Osterhoff G. Minimally displaced acetabulum fractures in geriatric patients: a comparison of open, percutaneous and non-operative treatment from the German Pelvic Injury Register data. Eur J Trauma Emerg Surg. 2021; 47:1763–71. https://doi.org/10.1007/s00068-020-01346-9.

    Article  PubMed  Google Scholar 

  29. Cimerman M, Kristan A, Jug M, Tomaževič M. Fractures of the acetabulum: from yesterday to tomorrow. Int Orthop. 2021; 45:1057–64. https://doi.org/10.1007/s00264-020-04806-4.

    Article  PubMed  Google Scholar 

  30. Gay SB, Sistrom C, Wang G‑J, Kahler DA, Boman T, McHugh N, et al. Percutaneous screw fixation of acetabular fractures with CT guidance: preliminary results of a new technique. Ajr Am J Roentgenol. 1992;158(4):819–22.

    Article  CAS  PubMed  Google Scholar 

  31. Rommens P. Is there a role for percutaneous pelvic and acetabular reconstruction? Injury. 2007;38(4):463–77.

    Article  CAS  PubMed  Google Scholar 

  32. Schweitzer D, Zylberberg A, Córdova M, Gonzalez J. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury. 2008;39(8):869–74.

    Article  PubMed  Google Scholar 

  33. Eckardt H, Egger A, Hasler RM, Zech CJ, Vach W, Suhm N, et al. Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: assessment of complications and factors influencing failure. Injury. 2017;48(12):2717–23.

    Article  PubMed  Google Scholar 

  34. Parker PJ, Copeland C. Percutaneous fluoroscopic screw fixation of acetabular fractures. Injury. 1997;28(9–10:597–600.

    Article  Google Scholar 

  35. Hong G, Cong-Feng L, Cheng-Fang H, Chang-Qing Z, Bing-Fang Z. Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based computerized navigation. Arch Orthop Trauma Surg. 2010;130(9):1177–83.

    Article  PubMed  Google Scholar 

  36. Zhang L, Yin P, Zhang W, Li T, Li J, Chen H, Yao Q, Tang P. An effective and feasible method,“hammering technique,” for percutaneous fixation of anterior column acetabular fracture. Biomed Res Int. 2016. https://doi.org/10.1155/2016/7151950.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kazemi N, Archdeacon MT. Immediate full weightbearing after percutaneous fixation of anterior column acetabulum fractures. J Orthop Trauma. 2012;26(2):73–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. orthopedic surgery of medical science, Shahid Beheshti University of Medical Sciences, Akhtar hospital, Tehran, Iran

    Mohammad Qoreishy, Abdoreza Sajedi &  Arash Maleki

  2. Tehran, Iran

    Morteza Gholipour

  3. Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mona Gorji

Authors
  1. Mohammad Qoreishy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abdoreza Sajedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Morteza Gholipour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mona Gorji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arash Maleki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arash Maleki.

Ethics declarations

Conflict of interest

M. Qoreishy, A. Sajedi, M. Gholipour, M. Gorji and A. Maleki declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: IV

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qoreishy, M., Sajedi, A., Gholipour, M. et al. Clinical results of acetabular fracture treatment with hybrid fixation by anterior and posterior approach. Wien Klin Wochenschr (2023). https://doi.org/10.1007/s00508-023-02277-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00508-023-02277-2

Keywords

Search

Navigation