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Extraarticular fractures after periacetabular osteotomy.
Norman Espinosa1, Joshua Strassberg, Etienne L Belzile
1Department of Orthopaedics, University of Zurich, Zurich, Switzerland.
Clinical Orthopaedics and Related Research
|May 10, 2008
Summary
Extraarticular pelvic fractures after periacetabular osteotomy can cause significant morbidity, particularly ischial fractures. However, these fractures do not appear to impact long-term hip stability or clinical outcomes.
Area of Science:
- Orthopedic surgery
- Pelvic reconstruction
- Trauma surgery
Background:
- Extraarticular pelvic ring fractures can occur post-periacetabular osteotomy (PAO).
- These fractures may compromise acetabular fragment stability and lead to adverse outcomes.
- Understanding the implications of these specific fractures is crucial for patient management.
Purpose of the Study:
- To evaluate the clinical course and outcomes of patients experiencing extraarticular pelvic fractures after PAO.
- To compare the effects of pubic versus ischial fractures on patient recovery and long-term results.
Main Methods:
- Retrospective review of 17 patients (17 hips) with post-PAO extraarticular pelvic fractures.
- Fractures involved either the os pubis (12 patients) or os ischium (5 patients).
- Data collected on fracture type, treatment, complications, and clinical/radiographic outcomes.
Main Results:
- Ischial fractures were more debilitating, with 2/5 resulting in painful nonunions requiring surgery.
- Pubic fractures led to fewer complications, with only 1/12 needing additional surgery.
- Ischial fractures had a longer symptom resolution time compared to pubic fractures.
- No significant effect on acetabular fragment positioning or long-term clinical outcomes was observed.
Conclusions:
- Extraarticular pelvic fractures, especially ischial, are a notable complication after PAO, causing significant short-term morbidity.
- Despite potential complications like nonunion, these fractures do not seem to negatively influence the longer-term clinical outcome or acetabular stability.
- Awareness of this complication is essential for managing patient expectations and rehabilitation post-PAO.
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