Iliofemoral approach and its modified approaches for treatment of acetabular fractures involving the roof column and roof wall
10.3760/cma.j.cn115530-20240921-00384
- VernacularTitle:髂股入路及其改良入路在累及顶柱和顶壁的髋臼骨折治疗中的应用
- Author:
Guqi HONG
1
;
Siyuan QING
1
;
Yu ZHANG
1
;
Jiahu FANG
1
;
Xiaodong QIN
1
Author Information
1. 南京医科大学第一附属医院骨科，南京 210029
- Publication Type:Journal Article
- Keywords:
Acetabulum;
Fractures, bone;
Fracture fixation, internal;
Surgical approach;
Tips and tricks of iliofemoral approach
- From:
Chinese Journal of Orthopaedic Trauma
2024;26(12):1027-1033
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the iliofemoral approach and its modified approaches in the treatment of acetabular fractures involving the roof column and roof wall.Methods:A retrospective study was conducted to analyze the data of 19 patients who had been admitted to Department of Orthopaedics, The First Hospital Affiliated to Nanjing Medical University for acetabular fractures involving the roof column and roof wall from June 2015 to July 2023. There were 12 males and 7 females with an age of (53.5±15.6) years. By the three-column classification for the acetabular fractures, there were 2 cases of type A, 7 cases of type B, and 10 cases of type C. The time from injury to surgery was 6(5, 11) days. All patients underwent surgery through the iliofemoral approach or its modified approaches (the iliofemoral approach in 2 cases, the modified iliofemoral two-window approach in 13 cases, and the modified expanded iliofemoral two-window approach in 4 cases). All patients were fixated with plates and screws after reduction. The surgical time, intraoperative bleeding, complications, quality of fracture reduction, and hip joint function of the affected side were analyzed.Results:For all the 19 patients, the surgical time averaged (186.8±81.3) minutes, and the intraoperative bleeding volume 500(400, 600) mL. After acetabular fracture surgery, anatomical reduction was achieved in 13 cases and satisfactory reduction in 6 cases. The follow-up period for the 19 patients was (42.6±25.9) months. All acetabular fractures achieved bony union after a post-surgery duration of 14(12, 16) weeks. By the modified Merle d'Aubigné & Poster scoring system, the hip function was evaluated at the last follow-up as excellent in 4 cases, as good in 14 cases, and as fair in 1 case. Follow-ups revealed injury to the lateral femoral cutaneous nerve after surgery in 11 patients, of whom 5 were fully recovered and 6 partially recovered after treatment. Ectopic ossification developed after surgery in 3 patients, of whom 1 was rated as Brooker grade Ⅰ and 2 were as Brooker grade Ⅱ.Conclusion:In the treatment of acetabular fractures involving the roof column and roof wall, fixation with plates and screws through the iliofemoral approach or its modified approaches may achieve fine clinical outcomes in addition to the advantages of operative convenience and high safety.
