The use of trochanteric slide osteotomy in the treatment of displaced acetabular fractures

Abstract

From January 2003 and February 2006, 31 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a single approach, involving a straight lateral incision centered over the greater trochanter, trochanteric osteotomy and dislocation of the femoral head. The mean age of the patients was 48 (range 20-74 years) with a mean follow up 24 months (range from 20 to 42 months). Ten fractures were classified as simple, and 21 as complex fractures. The mean time to surgery was 4.5 days (range from 0 to 14 days). Mean operating time was 118 min (range 52-168). Five patients presented with posterior dislocation of the hip joint at the time of initial presentation. The trochanteric fragment was fixed with three 3.5mm cortical screws. Congruent reduction was achieved in all patients and all osteotomies healed within 5 months. Clinical evaluation was based on the modified Merle d'Aubigne and Postel scoring. Motor strength of abduction was evaluated according to the Medical Research Council grading. Clinical scoring was excellent to good in 24%. The strength of the abductors was grade 0/5 in a patient with Brooker's class IV heterotopic ossification, and 3/5 in the two patients with necrosis of the femoral head. There were five patients with grade 4/5 and the 5/5 in the rest. Complications included two segmental femoral head necrosis, one of them combined with necrosis of the weight bearing acetabular dome area. These patients required total hip replacement. Mild heterotopic ossification grade II was seen in one patient and significant (grade IV), in another patient. Two patients developed superficial wound infection over the trochanteric area and another two patients persistent pain due to irritation caused by the screws. One patient developed peroneal nerve palsy which resolved 3 months after the surgery. The trochanteric slide osteotomy can enhance the exposure of the whole acetabulum and the femoral head. This allows better evaluation of any osteochondral lesions, intra-articular bony fragments and fracture steps, providing a more accurate reduction and easier fixation of the acetabular fracture.