Kamalasekaran, D (2013) A Prospective study of Functional Outcome analysis of Open reduction and internal fixation of complex acetabular fractures. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Over the last 20 years, Improvements in automobile safety, prehospital care, resuscitation, and transport as well as standardized protocols for treatment have all contributed to improved survival after severe pelvic injuries. Only 10% of the pelvic disruptions involve acetabulum. Posterior wall fractures are most common, comprising 24% of acetabular fractures. The primary cause in younger individuals is high-energy trauma. Acetabular fractures generally occur in conjunction with other fractures. The treatment of acetabular fractures is an enigmatic area of orthopaedics that is being continually refined. It involves a definite learning curve. Acetabular fractures are generally associated with other injuries of the pelvis and lower limbs which may influence treatment options, surgical approach and clinical outcomes. Patient age, fracture stability, the presence of comorbidities and osteoporosis, combined with surgeon experience also influence treatment options. AIM OF THE STUDY: The aim of this study is to analyze the results and functional outcome of open reduction and internal fixation in patients with complex acetabular fractures. MATERIALS AND METHODS: This is a prospective study done to assess the functional and outcome of complex acetabular fractures treated by open reduction and internal fixation in 20 patients over the period of two and half years from April 2010-October 2012 at Our Institute of Orthopaedics and Traumatology , Madras medical college and Rajiv Gandhi Government general hospital, Chennai. Inclusion criteria consists of • Age greater than or equal to 18 years, • Closed fractures, • Complex acetabular fractures including, • Transverse fractures, • Transverse with posterior wall fracture, • T Type fracture. • Anterior column or wall with posterior hemitransverse fracture, • Both column fractures. Excluson criteria: • Open injuries, • simple fractures, • fracture greater than 3 weeks old, • patient operated within last six months. In our study after general resuscitation of the patients, a detailed clinical examination and radiological assessment was done. Patients were put on skeletal traction. Patients were operated between 5 to 10 days based on Damage Control Orthopaedics. RESULTS: Twenty patients with complex acetabular fractures were treated surgically and analysed with average follow up of 10.5 months ranging from 6 months to 2½ years . The following observations were made. 1) 75% belong to less than 40 years. 35% patients belong to 4th decade followed by 3rd decade (25%). 2) Males dominated our study group with a ratio of 9: 1. 3) Road traffic accidents contributed to the injury in 80% of our patients and rest sustained by fall from height. 4) Transverse fracture was the most common type in our study (7 cases). Anterior column with posterior hemitransverse was least common type (2 cases). 5) Eight patients had associated skeletal injuries. One patient had sciatic nerve injury and one patient had urethral injury. CONCLUSION: We conclude that Complex acetabular fractures treated by open reduction and internal fixation have a satisfactory functional outcome. Use of non extensile approaches itself is sufficient to produce adequate fracture reduction with reduced complications. Every chance of reducing the fragments anatomically, fixing rigidly and mobilizing early must be done for better function which is not possible by conservative means. Treatment of acetabular fractures is a challenging task for any orthopaedic surgeon. With definite learning curve, proper pre operative planning, non extensile exposure, accurate reduction, rigid fixation and early rehabilitation, it is possible to produce a improved outcome.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Functional Outcome analysis, Open reduction, internal fixation, complex acetabular fractures. |
| Subjects: | MEDICAL > Orthopaedics |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Sep 2017 03:46 |
| Last Modified: | 27 Mar 2020 07:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3139 |
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