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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 June;59(3):133-9
Delayed displaced transverse acetabular fracture: trochanteric flip osteotomy and surgical dislocation of the femoral head for accurate reduction
Bruno L., Rollero L., Matteotti R., Aprato A., Gallo A., Sabatini L., Zoccola K., Massè A.
Divisione di Chirurgia del Bacino Azienda Ospedaliera CTO – CRF – Maria Adelaide, Torino, Italia
Aim. A precise surgical restoration of the articular surface is the most important prognostic factor in acetabular fractures, but the clinical outcome is also due to many other aspects, like the anatomical classification of the fracture and the correct timing of surgical procedures.The aim of this paper is to carry out a survey of scientific literature concerning surgical procedures in the treatment of complex delayed acetabular fractures.
Methods. The case of a patient hospitalized at the Turin’s Centre of Orthopaedics and Traumatology is studied: she showed a transverse and posterior wall acetabular fracture with complex and delayed pelvic bones’ fractures, treated with trochanteric flip osteotomy and surgical dislocation of the femoral head for accurate reduction. Literature researches using PubMed were performed with the keywords “acetabular fractures”, “chronic acetabular fractures”, “delayed acetabular fractures”, “acetabular dislocation”, “ileo-femoral ap-proach”, “Kocher-Langenbeck approach”, “trochanteric osteotomy”, “surgical dislocation of the hip” differently combined. Inclusion criteria: English, French, Italian, German language; retrospective studies, case-control studies, reviews, case reports, original articles.
Results. The results obtained were: 3 articles concerning acetabular fractures’ classification, 8 articles for prognostic factors, 11 articles for surgical procedures, 3 articles for trochanteric flip osteotomy and surgical dislocation of the femoral head. Eight articles concerned retrospective studies, 2 case-control studies, 7 reviews, 4 case report and 4 original articles.
Conclusion. When delayed, the accurate reduction of acetabular fractures is more difficult to obtain, and it often needs complex and aggressive surgical procedures, which present a significant approach-related rate of morbidity. Trochanteric flip osteotomy and surgical dislocation of the femoral head allow a good intra-articular assessment and improve anatomical restoration’s chances, with a better outcome for the patient.