Clinical results of acetabular fracture management with the Pararectus approach

Keel, Marius; Tomagra, Salvatore; Bonel, Harald Marcel; Siebenrock, Klaus-Arno; Bastian, Johannes (2014). Clinical results of acetabular fracture management with the Pararectus approach. Injury - international journal of the care of the injured, 45(12), pp. 1900-1907. Elsevier 10.1016/j.injury.2014.10.040

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INTRODUCTION To present the accuracy of reduction, complications and results two years after open reduction and internal fixation of displaced acetabular fractures involving the anterior column (AC) through the Pararectus approach. Frequencies for conversion to total hip replacement in the early follow up, the clinical outcome in preserved hips, and the need for an extension of the approach (1st window of the ilioinguinal approach) are compared to the literature about the modified Stoppa approach. METHODS Forty-eight patients (mean age 62 years, range: 16–98; 41 male) with displaced acetabular fractures involving the AC (AC: n = 9; transverse fracture: n = 2; AC and hemitransverse: n = 24; both column: n = 13) were treated between 12/2009 and 12/2011 using the Pararectus approach. Surgical data and accuracy of reduction (using computed tomography) were assessed. Patients were routinely followed up at eight weeks, 6, 12 and 24 months postoperatively. Failure was defined as the need for total hip arthroplasty. Twenty-four months postoperatively the outcome was rated according to Matta. RESULTS In four patients there were four intraoperative complications (minor vascular damage in two, small perforations of the peritoneum in two) which were managed intraoperatively. Fracture reduction showed statistically significant decreases (mean ± SD, pre- vs. postoperative, in mm) in “step-offs”: 2.6 ± 1.9 vs. 0.1 ± 0.3, p < 0.001 and “gaps”: 11.2 ± 6.8 vs. 0.7 ± 0.9, p < 0.001. Accuracy of reduction was “anatomical” in 45, “imperfect” in three. Five (13%) from 38 available patients required a total hip arthroplasty. Of 33 patients with a preserved hip the clinical outcome was graded as “excellent” in 13 or “good” in 20; radiographically, 27 were graded as “excellent”, four as “good” and two as “fair”. An extension of the approach was infrequently used (1st window ilioinguinal approach in 2%, mini-incision at the iliac crest in 21%). CONCLUSION In the treatment of acetabular fractures involving the anterior column the Pararectus approach allowed for anatomic restoration with minimal access morbidity. Results obtained by means of the Pararectus approach after two years at least parallel those reported after utilisation of the modified Stoppa approach. In contrast to the modified Stoppa approach, a relevant extension of the Pararectus approach was almost not necessary.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Keel, Marius; Tomagra, Salvatore; Bonel, Harald Marcel; Siebenrock, Klaus-Arno and Bastian, Johannes

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0020-1383

Publisher:

Elsevier

Language:

English

Submitter:

Stefanie Zurbuchen

Date Deposited:

07 Apr 2015 11:36

Last Modified:

09 Nov 2015 11:26

Publisher DOI:

10.1016/j.injury.2014.10.040

PubMed ID:

25457342

BORIS DOI:

10.7892/boris.66180

URI:

https://boris.unibe.ch/id/eprint/66180

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