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Free iliac crest grafts with periosteum for treatment of old acetabular defects
De-wei Zhao1, Qiang Sun, Ben-jie Wang
1Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province 116001, China. gksys@126.com
Objective:
To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects.
Methods:
From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reduced. Bone graft was harvested from the iliac crest with periosteum, which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securely fixed by two to three leg screws.
Results:
Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32.3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases, good in 4 cases and fair in 2 cases.
Conclusions:
Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.