Abstract
Background
Older patients tend to have acetabular fractures with medial displacement patterns
and associated comminution, particularly of the quadrilateral surface. Our goal was
to investigate the appropriateness of open reduction and internal fixation using an
infra-pectineal buttress plate for osteopenic acetabular fractures.
Materials and method
We conducted a retrospective review involving twenty one consecutive patients over
the course of 4 years with an acetabular fracture in an academic level 1 trauma centre.
We performed the modified Stoppa approach with buttress plating of the quadrilateral
surface. Clinical examination radiographs was done using criteria described by Matta.
Functional outcome was evaluated using surveys including SF-12, WOMAC, Harris Hip
score and modified Postel Merle D’Aubigne.
Results
Average follow-up was 4.2 years with a minimum of 2 years. Mean age for patients was
64.3 years. We obtained anatomic reduction in 52.4% (11/21) of cases, imperfect reduction
in 38.1% (8/21) of cases and poor reduction in 9.5% (2/21) of cases. Significant loss
of reduction was seen in 2 patients. A superior dome impaction (a Gull sign) was correlated
to arthroplasty (p = 0.02) and reduced quality of initial reduction (p = 0.02). Two patients required re-intervention with a total hip arthroplasty. There
was one traumatic injury to the obturator nerve and 2 patients were noted to have
temporary weakness of the hip adductors postoperatively.
Conclusion
Internal fixation using the modified Stoppa approach to buttress the quadrilateral
plate should be considered a viable alternative to total hip arthroplasty for the
initial treatment of acetabular fractures in the elderly.
Keywords
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Article info
Publication history
Accepted:
November 22,
2010
Identification
Copyright
© 2010 Published by Elsevier Inc. All rights reserved.
