A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients

Abstract

Aim and objective: To study the radiological and functional outcomes as well as complications in the management of fractures involving both columns of the acetabulum using a single surgical approach.

Design: Type IV, prospective clinical study.

Setting: Level I trauma centre.

Materials and methods: Inclusion criteria were as follows: (a) patients over 20 year of age and (b) patients suffering from acetabular fractures involving both columns as per Letournel and Judet classification, namely transverse, transverse + posterior wall, T type, anterior column posterior hemi-transverse (ACPHT) and associated both columns. Exclusion criteria were as follows: (a) patient suffering from isolated anterior column, posterior column, anterior wall, posterior wall and posterior wall + column fractures; (b) patient who have undergone surgical procedures of the hip prior to trauma; and (c) compound acetabular fractures. A total of 23 patients having both column acetabulum fractures were included prospectively from June 2016 to December 2018 and followed up till 1 year postoperatively. Open reduction and internal fixation were performed through one of three described approaches, i.e., iliofemoral, Kocher-Langenbeck, and anterior intrapelvic or ilioinguinal.

Results: Our study population consisted of 30.4% transverse, 39.1% associated both columns, 21.7% T type and 8.7% anterior column + posterior hemi-transverse. Of these, 65.2% were operated using the Kocher-Langenbeck approach, while 30.4% of patients required the anterior intrapelvic approach. The remaining 4.3% of patients were operated by the iliofemoral approach. Anatomic reduction was achieved in 100% of our study population with remaining displacement less than or equal to 1°mm. At 1-year follow-up, all fractures showed a satisfactory union with an excellent Matta index in 100% study subjects. Complications at 1 year included one case of foot drop, which was present preoperatively but failed to improve and one case of post-traumatic arthritis. Average Harris Hip score (HHS) and mean Merle D'Aubigne (MDA) scores suggested good clinical outcomes in the study population.

Conclusions: A single approach can be used to achieve good functional and radiological outcomes in carefully selected bicolumnar fractures of the acetabulum, with less approach-related morbidity.

Clinical significance: Traditionally, multiple approaches are used for acetabulum fractures involving both columns, but with proper patient selection, single approach can be used with good functional and surgical outcomes.

How to cite this article: Patil A, Attarde DS, Haphiz A, et al. A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients. Strategies Trauma Limb Reconstr 2021;16(3):152-160.

Keywords: Acetabular fracture; Bicolumnar fracture acetabulum; Single-approach acetabulum.

Fig. 1

Age distribution

Flowchart 1

Algorithm to determine approach based on column involved

Fig. 2

VAS at 3, 6, and 12 months

Figs 3A and B

Box and Whisker chart showing MCS and PCS components at the follow-up

Figs 4A to F

Box and Whisker chart showing MCS and PCS scores among three different groups IL, Iliofemoral; KL, Kocher-Lagenbeck and Stoppas

Figs 5A to F

Preoperative radiographs and CT scan showing bicolumnar fracture

Figs 6A to C

Immediate post-operative radiographs showing good reduction through AIP approach

Figs 7A to C

1-year follow-up radiographs showing good osseous union

Figs 8A to C

Clinical outcome at 1 year

Figs 9A and B

Preoperative radiograph and CT scan showing bicolumnar acetabulum fracture

Fig. 10

Post-operative radiograph showing both fractures managed with iliofemoral approach

Figs 11A to C

Good radiological and functional outcomes at 1 year with single iliofemoral approach