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Balloon acetabuloplasty for cartilage impaction reduction in traumatic acetabular fractures: a case series and
Lorenzo Serfaty1,2, Guillaume Riouallon3, Elias Melhem3
1Orthopedic and Traumatology Surgery Department, Hôpital Paris Saint-Joseph, Paris, France. lorenzo.serfaty@aphp.fr.
Purpose:
Acetabular fractures with cartilage impaction are associated with a high risk of post-traumatic osteoarthritis, frequently requiring total hip arthroplasty (THA). Conventional open reduction and internal fixation (ORIF) often fail to restore joint surface congruity. This case series evaluates the radiological and clinical outcomes of a novel minimally invasive technique using balloon acetabuloplasty to reduce dome impaction in traumatic acetabular fractures.
Methods:
This retrospective case series included patients with acetabular fractures involving cartilage impaction. Balloon acetabuloplasty was indicated when the impaction was inaccessible through standard approaches or in isolated impaction cases suitable for percutaneous treatment. Step and gap were measured on pre- and postoperative CT scans (St. Joseph Acetabular Score). Secondary outcomes included conversion to THA and functional evaluation using the Simple Hip Value (SHV) at latest follow-up.
Results:
Eight patients (mean age, 56 ± 8 years; 1 female, 7 males) were included. Mean follow-up was 22 ± 9 months (range, 9-31 months). Fracture types comprised three anterior column and posterior hemitransverse, one T-shaped fracture, one both-column, one transverse, one anterior wall and one posterior wall fracture. Four patients were treated using an open Stoppa approach and four with a percutaneous approach. The mean step was reduced from 8.6 to 0.7 mm (p = 0.014), and the gap from 3.5 to 1.0 mm (p = 0.021). Two patients (25%) required THA during follow-up. In the remaining six patients, mean Simple Hip Value (SHV) at latest follow-up was 92 ± 8%. No complications were reported.
Conclusion:
Balloon acetabuloplasty is a promising minimally invasive technique to address dome impaction in acetabular fractures. It may improve articular surface restoration and reduce the risk of progression to THA. Further studies are needed.