Management of acetabular fractures with modified posterior approach to spare external hip rotators

Şarlak, Ahmet Yılmaz; Selek, Özgür; İnanır, Murat; Musaoğlu, Resul; Baran, Tuncay

doi:10.1016/j.injury.2013.11.010

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…26,27 For transverse fractures, posterior column and posterior wall, a Kocher-Langenbeck approach is recommended, and in the case of anterior wall fracture and/or anterior column fractures, an ilioinguinal approach is preferred. [26][27][28][29][30] Recently, the use of a modified Stoppa approach proposed a surgical option for fracture with medial displacement of the quadrilateral plate along with a direct exposure of the fracture zone, but the learning curve for this approach is high. 31,32 In our study, a Stoppa approach was not performed.…”

Section: Discussionmentioning

confidence: 99%

Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?

Cahueque

Martinez

Cobar

et al. 2017

Journal of Clinical Orthopaedics and Trauma

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Section: Discussionmentioning

confidence: 99%

Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?

Cahueque

Martinez

Cobar

et al. 2017

Journal of Clinical Orthopaedics and Trauma

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“…36,37 These approaches can give access to the posterior ischium between sciatic nerve and posterior cutaneous nerve. 38 However, these approaches cannot be used for arthroplasty surgeries as they do not allow dislocation of the hip.…”

Section: Discussionmentioning

confidence: 99%

Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

Boettner

Rüeckl

2018

J Hip Surg

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Reconstruction of acetabular defects in revision total hip arthroplasty (THA) requires excellent exposure. Most extensile approaches to the acetabulum were described in the trauma literature and are not beneficial for revision THA. This article describes a modification of the standard posterior surgical approach to improve visualization of the ischium as required for acetabular defect reconstruction, insertion of standard and custom triflange cages as well as posterior column plating. The current surgical technique utilizes an intermuscular plane between the gemellus inferior muscle and the obturator externus muscle. This intermuscular plane leads the surgeon directly to the ischium and facilitates easy extension toward the insertion of the hamstring muscles without compromising the insertion of the external rotator muscles along the ischium. This article describes a novel surgical approach to the posterior column and ischium under special consideration of the sciatic nerve, superior gluteal vessels, and medial femoral circumflex artery. This simple extension of the standard posterior approach optimizes exposure of the posterior column during revision THA using a posterior approach.

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“…In most fractures gentle retraction of the gluteus medius to widen the superior portal is sufficient to reduce the displaced posterior fragment gently compressing it with a periosteal elevator. A curved 3.5 mm or 4.5 mm reconstruction plate (TIPSAN stainless steel reconstruction plate system) was passed underneath the spared piriformis and short external rotators extending from lateral ischium to the inferior iliac wing compressing the fractured fragment [15]. After reduction of the fracture, fixation was achieved (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

External Rotator Sparing with Posterior Acetabular Fracture Surgery: Does It Change Outcome?

Ceylan¹,

Selek

İnanır

et al. 2014

Advances in Orthopedics

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This study analyses the results of the treatment with external rotator sparing approach in acetabular fractures to determine whether muscle sparing has a positive impact on functional outcome. 20 patients with a mean age of 45.9 years (range: 26–64) that had been treated for displaced acetabular fractures were included in this series. Short Musculoskeletal Function Assessment (SMFA) questionnaire and hip muscle strength measurement were done at the 24-month of follow-up period. The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta. The average SMFA score for all of the patients was 18.3 (range: 0–55.4). The mean dysfunctional and bother indexes were 17.2 and 20.6, respectively. The overall muscle strength deficit was 11.8%. The greatest loss of strength was in internal rotation. In patients with better postoperative reduction quality of acetabular fracture, peak torque, and maximum work of hip flexion, extension and also internal rotation maximum work deficit were significantly lower (P < 0.05). Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures.

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Management of acetabular fractures with modified posterior approach to spare external hip rotators

Cited by 11 publications

References 18 publications

Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?

Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?

Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

External Rotator Sparing with Posterior Acetabular Fracture Surgery: Does It Change Outcome?

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