METHODS: It was a retrospective study carried out in a Level 1 arthroplasty and trauma centre. 23 patients (17 males, 6 females) with average age of 50.1 years (range, 36-68 years) with displaced acetabular fracture treated with combined incisions and plate-cable systems were included. There were 3 elementary and 18 associated fractures according to Letournel classification. Average follow-up was 23.5 months (range, 12-38.7 months). Mean operation time was 160min (range: 75-320min). Functional scores were evaluated using Harris Hip Score (HHS) whilst reduction was assessed by Matta criteria. Any displacement of reduction, osteoarthritis, heterotopic ossification, and other complications was recorded.
RESULT: 65.2% (15/23) of the patients obtained excellent HHS and 21.7% (5/23) had good HHS. There were 12 anatomical, 6 imperfect, and 5 poor reductions. No displacement was recorded in final follow-up. Complications documented: three lateral femoral cutaneous nerve injuries, two conversions to total hip arthroplasty, three Brooker stage 1 heterotrophic ossification, one pulmonary embolism and one screw irritation. No incidence of wound breakdown, infection and radiological osteoarthritis was reported.
CONCLUSIONS: Imperfect reduction of the anterior column provided clinical outcomes that are as good as total anatomical reduction. This approach minimizes soft tissue damage and reduces perioperative morbidities.
STUDY DESIGN: Experimental.
SAMPLE POPULATION: Fourteen equine cadaver limbs/horses.
METHODS: Simulated fractures were repaired with 2 lag screws under 4-Nm insertion torque (linear repair). Computed tomography (CT) imaging was performed with the leg unloaded and loaded to forces generated while walking. The fracture repair was revised to include 3 lag screws placed with the same insertion torque (triangular repair) prior to CT. The width of the fracture gap was assessed qualitatively by 2 observers and graded on the basis of gap measurements relative to the average voxel size at dorsal, mid, and palmar P1 sites. Interobserver agreement was assessed with Cohen's κ. The effect of repair type, loading condition, and measurement site on fracture gap grades was evaluated by using Kendall's τ-b correlation coefficients and paired nonparametric tests. Significance was set at P ≤ .05.
RESULTS: Agreement between loading and fracture gap widening was fair in triangular (κ = 0.53) and excellent in linear (κ = 0.81) repairs. Loading resulted in fracture gap distraction in linear repairs (Plinear = .008). Triangular repairs reduced fractures better irrespective of loading (Punloaded = .003; Ploaded