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How Safe is Antegrade Femoral Nailing in Ipsilateral Acetabulum Fractures Requiring Kocher–Langenbeck Approach? An Analysis of 23 Fractures

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Abstract

Objective

The ipsilateral acetabulum and femur fracture (IAFF) is an uncommon entity. This combination challenges the surgeon in the optimal management of each injury component, fixation sequence, surgical approaches, implant choices and complications. Inappropriate approach for one fracture may affect the fixation of another or modify the overall outcome. In this perspective, we aim to analyze our results in patients who underwent acetabulum fixation with Kocher–Langenbeck (K–L) approach and antegrade femur nailing (AFN), emphasizing the incidence of infection, skin necrosis and heterotopic ossification (HO).

Methods

During the five years, 22 patients with 23 IAFF (mean age of 36.5 years) were treated operatively. All the patients underwent K–L approach for acetabulum fixation and AFN for femur fracture. All the patients were treated under the supervision of a pelvi-acetabular trauma consultant. Demographic data, injury, surgical, and postoperative details were collected. The quality of acetabular reduction was evaluated using Matta’s criteria. The radiological outcome, obtained at final follow-up, was graded according to Matta’s criteria. Functional outcome was evaluated by Merle d’Aubigné and Postel system. HO was graded according to the Brooker system. Complications recorded were DVT, skin necrosis, infection, arthritis, HO, AVN and need for additional surgery.

Results

Out of 23, 11 had posterior dislocation, 6 had quadrilateral plate injury with central protrusion and six without dislocation. Femur fractures include 9-midshaft, 4-proximal third, 3-distal third, 3-trochanteric fractures and 4-segmental fractures. There were 11 elementary and 12 associated acetabulum fractures. 21 fractures underwent staged-fixation. Single-stage fixation was done in 2. In all cases treated with staged-fixation, AFN was done first. The mean duration of follow-up was 28 months (16–57). All femur fractures united with a mean union time of 21.3 weeks (11–37). The radiological outcome was excellent in 13, good in 4, fair in 3 and poor in 3. The functional outcome was excellent in 3, good in 11, fair in 4 and poor in 4 patients. None had skin necrosis. Three patients had infection. 14 (60.8%) hips had HO, with clinically significant HO (grade 4) in 2(8.6%). Six (26%) patients had arthritic changes. Four (17.3%) hips had avascular necrosis.

Conclusion

AFN is a viable option in IAFFs requiring a K–L approach under the supervision of a pelvi-acetabular surgeon. This combined approach per se does not demonstrate an increased risk of infection, wound healing problems or HO.

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Authors and Affiliations

  1. Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043, India

    Ramesh Perumal, Durga Prasad Valleri, Rakesh Kiran Yalavarthi, Shanmuka Babu Tumati & Dheenadhayalan Jayaramaraju

  2. Division of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, 641043, India

    Rajasekaran Shanmuganathan

Authors
  1. Ramesh Perumal
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  2. Durga Prasad Valleri
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  3. Rakesh Kiran Yalavarthi
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  4. Shanmuka Babu Tumati
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  5. Dheenadhayalan Jayaramaraju
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  6. Rajasekaran Shanmuganathan
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Correspondence to Ramesh Perumal.

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43465_2021_544_MOESM1_ESM.pptx

ESM_1: (A) Polytrauma with a head injury, bilateral acetabulum fracture with right femur shaft fracture treated with staged-fixation. All fractures united well with grade-II HO on the right side and grade-IV HO on the left side at 26-months follow-up. (B) Left hip implant removal and excision of HO was done. (PPTX 2011 kb)

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Perumal, R., Valleri, D.P., Yalavarthi, R.K. et al. How Safe is Antegrade Femoral Nailing in Ipsilateral Acetabulum Fractures Requiring Kocher–Langenbeck Approach? An Analysis of 23 Fractures. JOIO 56, 592–600 (2022). https://doi.org/10.1007/s43465-021-00544-w

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  • DOI: https://doi.org/10.1007/s43465-021-00544-w

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