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The management of the displaced medial wall in complex acetabular fractures using plates and additional cerclage
Myung-sik Park1, Sun Jung Yoon, Jong-hyuk Park
1Department of Orthopaedic Surgery, Biomedical Research Institute of Clinical Medicine, Chonbuk National University Hospital Jeonju, Chonbuk 561-712, Korea.
Insights
This study found that using additional cerclage cables can effectively reduce complex acetabular fractures, improving outcomes without harming the superior gluteal artery and nerve. This technique also reduces surgical time and blood loss.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Skeletal Biomechanics
Background:
- Displaced quadrilateral plates in acetabular fractures present significant reduction challenges.
- Current reduction methods often necessitate extensive surgical exposure.
Purpose of the Study:
- To evaluate the efficacy of supplementary cerclage cables in managing complex acetabular fractures.
- To assess the risk of superior gluteal artery and nerve compression associated with cerclage application.
Main Methods:
- Retrospective analysis of 31 hips with complex acetabular fractures.
- Clinical outcomes assessed using modified Matta grading and radiographic arthritic grades.
- Superior gluteal artery and nerve integrity evaluated via femoral angiography and EMG.
Main Results:
- 18 patients achieved very good to excellent outcomes; 5 good, 3 fair, and 5 poor.
- Preoperative femoral head injury, seagull sign, poor reduction, and delayed reduction significantly impacted clinical results.
- No instances of superior gluteal artery or nerve injury were observed with cerclage use.
Conclusions:
- Cerclage cabling is a valuable adjunct for reducing displaced medial plates in acetabular fractures.
- This technique offers reduced operative time and blood loss compared to alternative methods.
- The use of cerclage cables in this context is safe regarding neurovascular structures.
Abstract:
Reduction for displaced quadrilateral plates in complicated acetabular fractures is difficult and requires wide exposure. The purpose of this study is to assess the usefulness of the additional cable in this complicated fracture and to evaluate the potential danger of compressing the superior gluteal artery and nerve with cable application. We evaluated 31 hips (these included 25 hips with fractures of both columns, two posterior wall and column fractures, three anterior column and posterior hemitransverse fractures, and one high T-shaped fracture) with an average six-year follow-up. Clinical outcomes were evaluated using a modification of the Matta grading system and radiographic arthritic grades. We assessed the postoperative clinical outcomes in relation with other variables such as anatomical reduction, delayed operation, seagull sign, and femoral head injuries. We determined whether the superior gluteal artery and nerve were compressed by cerclage with the help of femoral angiography and EMG. Clinical outcomes were graded as very good to excellent for 18 patients, good for five, fair for three and poor for five. Preoperative femoral head injury (P = 0.011), a seagull sign (P = 0.001), poor reduction (P = 0.015), and delayed reduction (P = 0.05) were found to statistically influence clinical results. We found that there were no injuries to the superior gluteal artery and nerve in spite of using a cable. Cerclage methods can be useful for initial reduction of displaced medial plates in acetabular fractures. These methods reduce operation time and blood loss as compared with other methods.
