Gurumoorthy, M (2020) Study of Functional Outcome in Posterior Wall / Column Acetabular Fracture using Open Reduction Internal Fixation with Plates and Screws. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Before the era of Letournel and Judet the acetabular fractures were treated by closed or conservative method which gave poorer results with unstable painful joint. In 1964, after the extensive work done by Letournel and Judet and their publication of acetabular anatomy, injury pattern and management of acetabular fracture gave clear understanding of technique of reduction and implants to be used evolved leading to good results. However the management of the acetabular fracture still remains challenging and technically demanding due to complex anatomical relationship with adjacent structures. The subsequent studies by Letournel and Judet about displaced fractures of the acetabulum analyzed by imaging studies like x-ray and CT-scan with 3D reconstruction and best treated with open reduction and rigid internal fixation with plates and screws gave good results as compared to closed treatment. AIMS AND OBJECTIVES: 1. To assess the functional outcome of posterior wall and posterior column acetabular fracture treated by open reduction and internal fixation with plates and screws. 2. To study the fracture healing time clinically in acetabular fracture treated with internal fixation. 3. To assess the range of movements of hip joint and functional outcome after minimum follow up of 6 months using Modified Merle d’ Aubigne score. MATERIALS AND METHODS: Prospective study – 20 patients with posterior wall / column acetabular fracture who underwent open reduction and internal fixation with plates and screws at the Department of Orthopaedics, Govt. Stanley medical college during the period from July 2017 – September 2019. Pre-operative evaluation was done with Letournel and Judet views, Axial CT scan and 3D reconstruction scan. RESULTS: In this study, 20 patients were studied out of which 3 patients (15%) had posterior wall fracture, 8 patients (40%) had posterior column fracture, 3 patients (15%) had posterior wall with column fracture and 6 patients (30%) had posterior column with anterior column fracture. All the patients in this study were treated with open reduction and internal fixation with plates and screws through Kocher-Langenbeck approach. The functional outcome was assessed using Modified Merle d’ Aubigne and Postel score. The functional outcome which was evaluated with Modified Merle d’ Aubigne and Postel score was found to be excellent in 4 patients (20%), good in 11 patients (55%), fair in 2 patients (10%) and poor in 3 patients (15%). The post-operative fracture reduction was assessed on 3 plain radiographs and was graded as anatomical reduction in 12 patients (60%) and near anatomical reduction in 8 patients (40%). The mean time of injury to surgery was 9.1 days. We encountered complications such as Iatrogenic nerve in jury with foot drop in 2 patients (10%), 2 patients (10%) had infection and 1 patient (5%) developed heterotopic ossification. DISCUSSION: We have encountered 20 patients with fracture posterior wall / column acetabulum. So the Kocher-Langenbeck approach is the commonest surgical approach used. To achieve congruity of the joint open reduction internal fixation remains the best choice. Most important variable determining functional outcome was timing of surgery which is highlighted in many previous studies. CONCLUSION: To conclude, it involves a long learning curve and treatment should be done in a specialized tertiary care centre. Ideally, fracture posterior wall / column of acetabulum should be treated by open reduction and internal fixation. To produce good functional outcome surgery should be performed within 2 weeks of injury despite the complication.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221712052 |
| Uncontrolled Keywords: | Posterior wall/column, Modified Merle d’ Aubigne and Postel score, Kocher-Langenbeck approach, Letournel and Judet views. |
| Subjects: | MEDICAL > Orthopaedics |
| Depositing User: | Subramani R |
| Date Deposited: | 13 Feb 2021 13:47 |
| Last Modified: | 13 Feb 2021 13:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14100 |
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