Management of neglected acetabular fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Neglected acetabular fractures present complex management challenges.
• Traditional osteosynthesis is often inadequate due to femoral head damage, avascular necrosis, and fragment mobility issues.
• Total hip replacement (THR) is the primary treatment, but requires addressing associated complications like non-union and bone defects.

Purpose of the Study:

• To review the challenges and management strategies for neglected acetabular fractures.
• To discuss the role of advanced imaging and reconstructive techniques in THR for these complex cases.
• To evaluate the outcomes of THR in the context of neglected acetabular fractures.

Main Methods:

• Utilized 3D computed tomography (CT) scans for detailed acetabular and periacetabular anatomy assessment.
• Discussed reconstructive techniques including impaction grafting, antiprotrusio cages, and bone grafting for various bone defects.
• Outlined surgical approaches for fracture non-union, hip dislocation, and bone defects.

Main Results:

• 3D CT is crucial for pre-operative planning in neglected acetabular fractures.
• Specific techniques like impaction grafting and bone grafting can address cavitary and segmental bone defects.
• Despite advanced techniques, THR outcomes for neglected fractures remain poorer than for conventional hip replacements.

Conclusions:

• Management of neglected acetabular fractures requires careful consideration of bone defects and anatomical abnormalities.
• Advanced imaging and tailored reconstructive strategies are essential for successful THR in these cases.
• Outcomes of THR for neglected acetabular fractures are generally inferior to those of conventional hip replacements, highlighting the need for further research and improved techniques.