MINIMALLY INVASIVE FIXATION OF ACETABULAR FRACTURES

Abstract

Anatomical reduction of the joint is the primary aim in the treatment of acetabular fractures as any other articular fracture. The current standard approach provides open reduction and internal fixation (O.R.I.F.) through a variety of surgical approaches which have been associated with relatively high complications rate such as haematomas, deep infection, and neuro-vascular lesions. These procedures need long operative times with significant blood loss.

Many authors have demonstrated the feasibility of closed reduction and percutaneous fixation (C.R.P.F.) for minimally or non displaced acetabular fractures; this technique can be considered a valid alternative to O.RI. F. in order to decrease the morbidity related to surgical approaches.

Between 2001 and 2006 we performed C.R.P.F. for acetabular fractures in 15 patients; the reduction has been controlled with fluoroscopy during the operation and with CT scan after the operative procedure. The osteosinthesis has been performed with cannulated screws and In more complex cases the reduction has been achieved and maintained with ileo-femoral external fixation (ligamentotaxis technique).

Fractures were classified according to AO classification. Clinical and functional results have been evaluated according to Harris Hip Score on the base of post-operative CT scan and on x-ray films at last follow-up.

According to our experience the use of external fixation in the treatment of acetabular fractures must be reserved for very selected cases in which for general or local condition the joint the distraction associated with minimal internal fixation can guarantee good reduction and fracture stability avoiding the poor results of conservative treatment or the risk of major complications related to ORIF. The best reduction can be achieved when the treatment is carried out early while the best stability is achieved with the association of percutaneous cannulated screws. The use of external fixation has never compromised the range of movement of the hip.