J Korean Fract Soc.  2007 Jan;20(1):26-32. 10.12671/jkfs.2007.20.1.26.

Treatment of Acetabular Column Fractures with Limited Open Reduction and Screw Fixation

• Kim JJ
• Oh HK
• Kim SY

• KMID: 2294375
• DOI: http://doi.org/10.12671/jkfs.2007.20.1.26

Abstract

PURPOSE
To evaluate the results of limited open reduction and screw fixation of acetabular fractures.
MATERIALS AND METHODS
Six acetabular fractures were treated with fluoroscopic guided screw fixation. The mean age was 46 years old and mean follow-up period was 18 months. There were 3 anterior column fractures, 2 transverse fractures and 1 both column fracture. Anterior column screw fixation was used in 5 cases and posterior column fixation in 1 case. Limited ilioinguinal approach was used in 4 cases and percutaneous screw fixation in 2 cases.
RESULTS
The mean union time was 16.6 weeks. The postoperative radiographic results revealed 2 cases with an anatomic reduction and 4 cases with an imperfect reduction. The clinical results showed 1 case with excellent, 4 cases with good and 1 case with fair. Regarding complication, there was 1 case of SI joint penestration without clinical symptoms.
CONCLUSION
Limited open reduction and screw fixation can be a useful alternative treatment for acetabular fractures in patients with minimally displaced fracture, severe multisystem trauma and soft tissue injury not suitable to traditional treatment.

Keyword

Acetabular column fracture; Limited open reduction; Screw fixation

MeSH Terms

Acetabulum*
Follow-Up Studies
Humans
Joints
Soft Tissue Injuries

Figure

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  Fig. 1 For anterior column fixation, the screw direction is anterior to posterior from the AIIS to the inferior aspect of the greater sciatic notch. Iliac oblique view show optimal depth and confirm that the greater sciatic notch has not been violated.

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  Fig. 2 For posterior column fixation, the screw direction is inferior to superior from ischial tuberosity to the sciatic buttress. Pelvic lateral image and iliac oblique view confirms that the jont has not been violated.

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  Fig. 3 (A) A 59 year-old woman sustained both column open pelvic bone fracture. (B) Through open wound, three anterior column screws were fixed. After 2 year follow-up, solid bony union was achieved and clinical score was graded to fair.

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  Fig. 4 (A) A 47 year-old women complained of right hip pain and limping. Preoperative X-ray and CT scan show acetabular nonunion. (B) Using a limited ilioinguinal approach, bone graft and 3 anterior column fixation was carried out. The patient showed satisfactory result after 2 year follow-up.

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  Fig. 5 In the transverse fracture, supra-acetabular region has the cross-sectional bone area best suited to lag screw fixation. It can be seen that the screw would work best running from the ASIS to the greater sciatic notch.

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  Fig. 6 In the transverse fracture, posterior column was fixed with antegrade Steinmann pin during ilioinguinal approach.

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