Treatment of Incarcerated Impaction of Acetabular Fractures With Concomitant Osteochondral Femoral Head Fractures by the Use of a Posterior Wall Osteotomy and Surgical Hip Dislocation: A Novel Technique

Abstract

Acetabular articular impaction may well accompany acetabular fractures. Anatomic restoration of acetabular congruence is imperative to achieve longevity of the hip joint. Combination of incarcerated acetabular impaction with osteochondral femoral fracture is a true challenge for the pelvic surgeon to address. We describe a technique to treat a posterior column acetabular fracture in association with incarcerated articular impaction and concomitant osteochondral femoral fracture. Posterior wall osteotomy combined with surgical hip dislocation facilitates the restoration of femoral head anatomy and acetabular surface integrity. This technique should be considered when dealing with this difficult scenario.

Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments

“…The incidence of marginal impaction injuries associated with posterior wall fracture could reach up to 30% [ 29 ]; furthermore, detached fragments could be incarcerated inside the hip joint and need retrieval [ 32 ]. Several management options were described to treat such injuries, including surgical hip dislocation, posterior wall osteotomy, and hip arthroscopy; however, the previously mentioned options are considered technically demanding [ 35 – 38 ].…”

Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments

“…The incidence of marginal impaction injuries in association with posterior wall fracture could reach up to 30% [32]; furthermore, detached fragments could be incarcerated inside the hip joint and needs retrieval [29]. Several management options were described to treat such injuries, including surgical hip dislocation, posterior wall osteotomy, and hip arthroscopy; however, the previously mentioned options are considered technically demanding [33][34][35].…”

Padrão incomum de impacto marginal osteocondral em fraturas acetabulares: Um relatório de dois casos

“…Vários estudos demonstraram que os step-offs articulares são mal tolerados na cirurgia de fratura acetabular. 9 Assim, a importância de detectar um padrão tão incomum está em primeiro lugar: o cirurgião pode considerar este um fragmento solto que, se removido, pode afetar a superfície articular da articulação. Segundo: se o cirurgião suspeitar de tal lesão, é necessária uma cuidadosa distração articular para ajudar na redução desse fragmento ao seu leito com cautela para preservar a dobradiça interna onde o fragmento está preso à cartilagem articular.…”

“…Several studies have demonstrated that articular stepoffs are poorly tolerated in acetabular fracture surgery. 9 Hence, the importance of detecting such an unusual pattern lies in first: the surgeon might consider this a loose fragment that, if removed, could affect the joint articular surface. Second: if the surgeon suspects such injury, careful joint distraction is needed to help in reducing this fragment to its bed with caution to preserve the inner hinge where the fragment is attached to the articular cartilage.…”