Retrospective comparative study of surgical treatment of patients with fractures of the posterior acetabular wall

Authors

  • Yurii Prudnikov Research Institute of Traumatology and Orthopedics, Liman. Ukraine, Ukraine
  • Volodymyr Klimovitsky Research Institute of Traumatology and Orthopedics, Liman. Ukraine, Ukraine
  • Stanislav Bondarenko Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0003-2463-5919

DOI:

https://doi.org/10.15674/0030-59872020224-32

Keywords:

acetabulum, posterior wall, new minimally invasive approach, ORIF

Abstract

Background: The development of the new minimally invasive and less traumatic approaches for the treatment of acetabular fractures is a priority direction of modern orthopaedics. Objective: to compare the results of surgical treatment of patients with fractures of the posterior acetabular wall by using KocherLangenbeck approach and a new minimally invasive approach. Material and methods: A retrospective comparative study of the results of treatment of 72 patients with the posterior acetabular wall fractures was conducted. A control group of 38 patients were treated with traditional Kocher-Langenbeck approach, the main group of 34 patients were treated with new minimally invasive surgical approach to the acetabulum. A complex assessment of the treatment results was performed with the evaluation of bioelectrical activity of the lower limbs muscles by electromyography, and evaluation the peripheral circulation by rheovasography, the functional state of the hip after surgical treatment was assessed according to Harris Hip Score, and the amount of postoperative complications within 8 and 12 months after surgical treatment was accounted. Results: The proposed minimally invasive approach has a less negative influence to the functional activity to the pelvic muscles (m. gluteus maximus and m.quadriceps femoris) than traditional Kocher-Langenbeck approach in one year after surgery. According to rheovasography data we noticed a faster recovery of peripheral circulation in patients of the main group compared to the control one. Functional state of the hip joint by Harris Hip score in 1 year after surgery averaged in the main group (86.6 ± 15.9) points and (65.2 ± 20.4) in the control group. Complications occurred in 50% in the main group against 71% in the control. Conclusion: the obtained data allowed us to recommend a new developed minimally invasive approach for the treatment of posterior acetabular wall fractures.

Author Biographies

Volodymyr Klimovitsky, Research Institute of Traumatology and Orthopedics, Liman. Ukraine

MD, Prof. in Traumatology and Orthopаedics

Stanislav Bondarenko, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

Doctor of Traumatology and Orthopaedics

References

  1. Ezhov, Yu. I., Smirnov, A. A., & Labazin, A. L. (2003). Diagnosis and treatment of marginal acetabular fractures. Bulletin of Traumatology and Orthopedics them. N. N. Priorova, 3, 72-74. [in Russian]
  2. Babosha, V. A., Pasternak, V. N., & Lobanov, G. V. (1999). Surgical treatment of fractures of the posterior acetabulum. Orthopedics, traumatology and prosthetics, 2, 69-71. [in Russian]
  3. Giannoudis, P. V., Tzioupis, C., & Moed, B. R. (2007). Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. The Journal of Bone and Joint Surgery. British volume, 89(4), 503-509. doi: 10.1302/0301-620x.89b4.18380
  4. Gruson, K. I., & Moed, B. R. (2003). Injury of the femoral nerve associated with acetabular fracture. The Journal of Bone and Joint Surgery-American Volume, 85(3), 428-431. doi: 10.2106/00004623-200303000-00004
  5. Laird, A., & Keating, J. F. (2005). Acetabular fractures. The Journal of Bone and Joint Surgery. British volume, 87-B(7), 969-973. doi: 10.1302/0301-620x.87b7.16017
  6. Baumgaertner, M. R. (1999). Fractures of the posterior wall of the acetabulum. American Academy of Orthopaedic Surgeons, 5(7), 54-65.
  7. Tile, M. (2003). Fractures of the pelvis and acetabulum. Baltimor: Williams & Wilkins
  8. Matta, J. M., & Merritt, P. O. (1988). Displaced acetabular fractures. Clinical Orthopaedics and Related Research, &NA; (230), 83-97. doi: 10.1097/00003086-198805000-00009
  9. Ziran, N., Soles, G. L., & Matta, J. M. (2019). Outcomes after surgical treatment of acetabular fractures: A review. Patient Safety in Surgery, 13(1). doi: 10.1186/s13037-019-0196-2
  10. Lobanov, G. V., & Prudnikov, Yu. V. (2013). The results of surgical treatment of patients with fractures of the posterior wall of the acetabulum, treated in the traditional way using Kocher-Langenbeck Surgical Access. Trauma, 14(3), 9-12. [in Russian]
  11. Kanzuba, A. I., & Filippenko, V. A. (2004). Biomechanical approach to osteosynthesis for acetabular fractures. Trauma, 5(3), 268-273. [in Russian]
  12. Yoo, J., Hwang, J., Chang, J., & Oh, J. (2014). Management of traumatic labral tear in acetabular fractures with posterior wall component. Orthopaedics & Traumatology: Surgery & Research, 100(2), 191-196. doi: 10.1016/j.otsr.2013.12.016
  13. Hsu, C., Chou, Y., Li, Y., Chen, J., Hung, C., Wu, C., … & Yeh, T. (2018). Pre-operative virtual simulation and three-dimensional printing techniques for the surgical management of acetabular fractures. International Orthopaedics, 43(8), 1969-1976. doi: 10.1007/s00264-018-4111-8
  14. Sahu, R. L. (2018). Outcome of surgical treatment for displaced acetabular fractures: A prospective study. Revista Brasileira de Ortopedia (English Edition), 53(4), 482-488. doi: 10.1016/j.rboe.2017.12.007
  15. Gansslen, A., Grechenig, S., Nerlich, M., & Muller M. (2016). Standard approaches to the acetabulum part 1: Kocher-Langenbeck approach. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 83(3), 141-146
  16. Prudnikov, Y., Klymovytsky, V., Lobanov, G., & Khudobin, V. (2014). Comparative analysis of the back wall acetabulum injuries treatment using conventional and minimally invasive techniques. XXVI SICOT Triennial World Congress combined with the 46th SBOT Annual Meeting (Rio de Janeiro). http://www.sicot.org/rio-abstract-books.
  17. Lobanov, G. V., Khudobin, V. Yu., Prudnikov, Yu. V., & Oksymets, V. M. (2006). The method of access when surgical treatment of injuries in the hip area joint. Patent 19790 UA. [in Ukrainian]
  18. Lobanov, G. V., Prudnikov, Yu. V., Zhiliaev, R. A., Goncharova, L. D., & Tiazhelov, A. A. (2013). Minimally invasive method for treating posterior injuries walls of the acetabulum and its topographic and anatomical rationale. Herald of urgent and restorative medicine, 4(5), 184-188. [in Russian]
  19. Harris, W. H. (1969). Traumatic arthritis of the hip after dislocation and acetabular fractures. The Journal of Bone & Joint Surgery, 51(4), 737-755. doi: 10.2106/00004623-196951040-00012
  20. Becker, C. A., Kammerlander, C., Cavalcanti Kußmaul, A., Dotzauer, F., Woiczinski, M., Rubenbauer, B., … & Greiner, A. (2018). Minimally invasive screw fixation is as stable as anterior plating in acetabular T-type fractures – a biomechanical study. Orthopaedics & Traumatology: Surgery & Research, 104(7), 1055-1061. doi: 10.1016/j.otsr.2018.06.013
  21. Zhang, L., Xu, M., He, C., Du, H., Chen, H., Guo, Y., ... & Tang, P. (2010). Effectiveness of acetabular transverse and posterior wall fractures by Kocher-Langenbeck approach. Chinese Journal of Reparative and Reconstructive Surgery, 24(12), 1428-1431
  22. Magu, N., Rohilla, R., Singh, A., & Wadhwani, J. (2016). Modified Kocher-langenbeck approach in combined surgical exposures for acetabular fractures management. Indian Journal of Orthopaedics, 50(2), 206. doi: 10.4103/0019-5413.177570
  23. Magu, N. K., Rohilla, R., Arora, S., & More, H. (2011). Modified Kocher–langenbeck approach for the stabilization of posterior wall fractures of the acetabulum. Journal of Orthopaedic Trauma, 25(4), 243-249. doi: 10.1097/bot.0b013e3181f9ad6e
  24. Josten, C., & Trabold, O. (2011). Modified “2-Portal” Kocher–langenbeck approach: A minimally-invasive procedure protecting the short external rotator muscles. Journal of Orthopaedic Trauma, 25(4), 250-257. doi: 10.1097/bot.0b013e3181d3d544

How to Cite

Prudnikov, Y., Klimovitsky, V., & Bondarenko, S. (2023). Retrospective comparative study of surgical treatment of patients with fractures of the posterior acetabular wall. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (2), 24–32. https://doi.org/10.15674/0030-59872020224-32

Issue

Section

ORIGINAL ARTICLES