acetabular fractures surgical management kregor 2011
DESCRIPTION
manajemen bedah fraktur acetabularTRANSCRIPT
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Acetabular Fractures:Surgical Management
Philip J. Kregor, MD
Created March 2004, Revised 2007 and 2011
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Objectives Goal of Operative Management
Specific Approaches for Specific Fractures Indications for Kocher-Langenbeck Approach
Indications for Ilioinguinal Approach Reduction Strategies
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Letournel School
Thorough Understanding of Plain Films Optimize One Surgical Approach
Goal of Perfect Concentric Reduction
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Approaches to the Acetabulum
Posterior: Kocher - Langenbeck Anterior: Ilioinguinal
Extensile: Extended Iliofemoral
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Kocher-Langenbeck Approach
Langenbeck (1874): Superior Limb Kocher (1904): Inferior Limb Judet and Lagrange (1958)
Letournel
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Indications in Acute Acetabular Fxs
Posterior Wall Fractures
Posterior Column Fractures
Posterior Column / Posterior Wall Fractures
Juxta-tectal / Infra-tectal Transverse or Transverse with Posterior Wall Fractures
Some “T-type” Fractures
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Access: Kocher-Langenbeck
Entire Posterior Column Greater and Lesser Sciatic Notches
Ischial Spine Retro-Acetabular Surface
Ischial Tuberosity Ischio-Pubic Ramus
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Prone Position
Aids in Reduction of Ischiopubic Segment Facilitates Palpation of Quadrilateral Surface
Allows Clamp Placement through Greater Sciatic Notch
Easier Prep and Drape
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Judet Table
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POSTERIOR WALL FRACTURES
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Posterior Wall Fxs: Surgical Keys
Avoid Devascularization of Fragment/s Remove Intra-articular Fragments
Address Marginal Impaction Provide adequate buttress
Avoid Over-Contouring of Plate
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CONTROLLED DISTRACTION OF HIP JOINT
FEMORAL DISTRACTOR TRACTION TABLE
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POSTERIOR WALL FX
63 Y.O. MALE
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L.W. 00.09.23
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L.W. 00.09.23
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L.W. 00.09.23
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L.W. 00.09.23
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L.W. 00.10.25
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L.W. 00.10.25
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L.W. 00.10.25
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SPECIAL CASE:EXTENDED POSTERIOR WALL
??? GANZ TROCHANTERIC FLIP OSTEOTOMY TO VISULIZE FRACTURE WITHOUT DEVITALIZING
ABDUCTORS
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T.D. 00.02.01
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T.D. 00.02.01
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T.D. 00.02.01
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T.D. 00.02.01
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T.D. 00.02.08
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T.D. 00.02.17
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Reduction Aids: Kocher-Langenbeck Approach
Distal Femoral Traction Distraction of Hip Joint
Ischial Tuberosity Schantz Pin Quadrangular Clamp through Greater Sciatic
Notch Farabeuf Clamp
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FAERBEUF CLAMPS
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M.M. 98.10.27
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M.M 98.10.29
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M.M. 98.11.04
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M.M. 98.11.05
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M.M. 98.11.05
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TRANSTECTAL TRANVERSE ACETABULAR FX
18 Y.O. MALE
ISOLATED INJURY
SKINNY PATIENT / TREATED EARLY
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W.M. 99.11.27
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W.M. 99.11.27
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W.M. 99.11.27
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W.M. 99.11.27
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W.M. 00.01.12
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W.M. 00.01.12
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W.M. 00.01.12
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16 YEAR OLD FEMALE
IRREDUCABLE HIP DISLOCATION
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T-TYPE FRACTURE REDUCTION OF ANTERIOR COLUMN,
FOLLOWED BY POSTERIOR COLUMN REDUCTION OF POSTERIOR COLUMN,
FOLLOWED BY ANTERIOR COLUMN CREATION OF INTACT ISCHIOPUBIC
SEGMENT, FOLLOWED BY REDUCTION TO THE INTACT ILIUM
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Farless, Ron 02.07.29
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FACTORS COMPLICATING TRANSVERSE FRACTURE
REDUCTION TRANSTECTAL FRACTURE PATTERN
SEPARATE OSSEOCHONDRAL ARTICULAR DOME FRAGMENT
IPSILATERAL S.I. JOINT INJURY
SYMPHYSIS INJURY OR CONTRALATERAL ANTERIOR RING
INJURY
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Ilioinguinal Approach: Indications
Anterior Wall Anterior Column
Transverse with significant Anterior Displacement
Anterior Column / Posterior Hemitransverse Both Column
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Ilioinguinal Approach: Access
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Ilioinguinal Approach
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CASE 4: 63 YEAR OLD ROMAN CATHOLIC PRIEST
FELL GOING DOWN STAIRSWHAT IS THE DIAGNOSIS ??
WARNING: MAKE THE DX WITHOUT C.T.
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WHAT IS THE DIAGNOSIS ?
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TREATMENT OPTIONS?
NON-OPERATIVE?ORIF?
TOTAL HIP?
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ORIF ANTERIOR COLUMN ACETABULAR FRACTURE
SUPINE WITH FX TABLEILIOINGUINAL APPROACH
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NORMAL HIP AT 3 YEAR FOLLOW-UP
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R.C. 00.03.09
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R.C. 00.03.09
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R.C. 00.03.09
SPURSIGN
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R.C. 00.03.09
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R.C. 00.03.09
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A.S.I.S.
SYMPHYSIS
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EXT.OBL.
A.S.I.S.
EXT. INGUINAL RING
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A.S.I.S.
L.F.C.N.
PSOAS
EXT.OBL.
EXT.OBL.
CONJOINT TENDON
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INTACT ILIUM
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R.C. 00.03.10
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Limitations: Kocher-Langenbeck
Superior Acetabular Region Anterior Column
Fractures High in Greater Sciatic Notch
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Extended Iliofemoral Approach
“T” Type Fractures
Trans-tectal Transverse Fractures
Delayed Reconstruction
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Extended Iliofemoral Approach
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R.H. 98.11.21
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R.H. 98.11.21
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R.H. 98.11.22
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R.H. 98.11.22
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Anterior Column / Posterior Hemitransverse Acetabular
Fractures
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Anterior Column / Posterior Hemitransverse
Anterior Wall or Column
Posterior Half of Transverse Fracture
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ANTERIOR COLUMN FRACTURES
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ANTERIOR WALL FRACTURE
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Jeff Mast, M.D.
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R.M. 98.08.15
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R.M. 98.08.15
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R.M. 98.08.15
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R.M. 98.08.15
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R.M. 98.08.15
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R.M. 98.08.15
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R.M. 98.08.15
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R.M. 98.08.24
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R.M. 99.02.17
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R.M. 99.02.17
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R.M. 99.02.17
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H.S. 99.10.02
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H.S. 99.10.02
NO SPUR SIGN
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H.S. 00.04.12
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H.S. 00.04.12
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H.S. 00.04.12
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SPECIAL CASE:Pipkin IV addressed through Ganz Trochanteric Flip Osteotomy with
Surgical Dislocation
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CONCLUSIONS
Good Understanding of the Fracture Know the Anatomy
Optimize One Surgical Approach
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THANK YOU
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Acknowledgment
Return to Pelvis Index
E-mail OTA about Questions/Comments
If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to [email protected]