Isometry as a predictor of osteosynthesis result in fractures of the posterior acetabulum

Abstract

Introduction More than 80% of injuries to the acetabulum involve its posterior parts or injuries associated with their destruction. Most poor outcomes of surgical treatment of acetabular fractures manifest themselves in the first 24 months. Surgeons consider accurate anatomical reduction of fragments to be the main predictor of good results. A number of researchers showed good results of its surgical treatment, including those with inaccurate reduction. Poor results also occur in patients with no risk factors and ideal reduction. Thus, inaccurate reduction does not always lead to poor results; the reasons for positive results have not been discussed. Purpose To evaluate the effect of maintaining hip joint isometry in surgical approach on the outcome of reconstructive operations in the treatment of traumatic destruction of the posterior parts of the acetabulum. Materials and methods From 2005 to 2021, surgeons from the Moscow Regional Research and Clinical Institute performed 120 reconstructive operations on 120 patients with fractures of the posterior structures of the acetabulum. Of these, 84 patients followed the recommended monitoring regimen, completed the Harris Questionnaire, and had radiographs taken within the specified time frame. From the 84 patients, two groups of 42 patients each were formed that differed in the method of treating the external rotators. Results During two years of follow-up after reconstructive surgery on the acetabulum, clinical indications for hip replacement were identified or hip replacement was performed in 5 patients in the first group and in 25 patients in the second (11.9 and 59.5%, respectively). Discussion Accurate reduction of fragments is considered to be the main condition for good results after reconstructive operations for fractures of the posterior part of the acetabulum. Maintaining the isometry in the joint, namely, cutting off and then reinserting external rotators while preserving the attachment sites and length of the muscles, can have a significant impact on the outcome of reconstructive operations for traumatic injuries of the posterior parts of the acetabulum due to maintaining isometry of the hip joint. It seems that the preservation of force vectors centering the femoral head in the acetabulum causes the growth of ossification that forms secondary congruence. Conclusions Maintaining hip joint isometry in surgical treatment of fractures of the posterior acetabulum by changing the method of treating the external rotators provides significantly better clinical outcomes.

Keywords

• acetabulum fracture
• osteosynthesis
• joint arthroplasty
• kocher – langenbeck approach
• modification