Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture / 대한정형외과학회잡지

PURPOSE: Both column and T-shaped acetabular fractures are frequently presented with difficulty in reduction. Incomplete reduction may cause traumatic arthritis in the hip joint, resulting in inferior clinical outcomes. The purpose of this study is to introduce our wiring technique and to report the clinical and radiological outcomes of such technique. MATERIALS AND METHODS: Eight patients who underwent our proposed technique for having acetabular fracture with displaced quadrilateral plate between March 2013 and December 2014 were enrolled. All patients were followed-up more than 1 year. The wire passer was set up from an anterolateral aspect of the iliac crest to the greater sciatic notch, between the abductor muscle and the periosteum. The quadrilateral plate of acetabular fracture was reduced with wiring. Internal fixation was added to the pelvic brim. An analysis of the clinical and radiological outcomes was performed. RESULTS: Reduction was performed within the 3 mm intra-articular step-off in all patients. The mean duration of union was 11.8 weeks (9-15 weeks). Five patients (62.5%) showed excellent results, and radiologically, three patients (37.5%) showed good results, and seven patients (87.5%) showed better than good results. CONCLUSION: The cerclage wiring fixation technique using a large cerclage passer instrument can be a useful and safe reduction method in some cases of acetabular fractures.

Comparative Results of Acetabular Both Column Fracture According to the Fixation Method

PURPOSE: We wanted to compare the clinical and radiological results of surgical treatment of acetabular both column fracture according to the fixation method. MATERIALS AND METHODS: Between 1986 and 2008, 55 patients who underwent surgical treatment for acetabular both column fracture were clinically and radiologically evaluated after a minimum follow-up of one year. Of 55 patients, 29 cases were operated with a cerclage wire or cable (group I) and 26 cases were operated with a plate and screw (group II). The surgical approach, the intra- and post-operative complications and the reduction quality were compared between the two groups. The clinical and radiological results were analyzed according to the criteria reported by Matta. RESULTS: There were 14 (48.3%)/20 (76.9%) cases of anatomical reduction, 12 (41.4%)/6 (23.1%) cases of imperfect reduction, 1/0 case of poor reduction and 2/0 cases of surgical secondary incongruence, respectively. Thirty three patients of 34 anatomically reduced patients showed excellent clinical results and the anterior and posterior combined approach was frequent in group I. There were no differences between the two groups for the complications, although intraoperative complication was more frequent in group II and postoperative complication was more frequent in group I. CONCLUSION: The clinical and radiological results of surgical treatment in patients with both column fracture were satisfactory in both groups. However, the concerns related to the surgical approach and complications will require a randomized prospective study.

Indirect Reduction of Posterior Column through Ilioinguinal Approach in Case of Both Column Fractures

PURPOSE: To evaluate the efficacy and results of indirect reduction of the posterior column through the ilioinguinal approach in cases of both column fractures. MATERIALS AND METHODS: Between February 2000 and January 2008, 18 patients, who underwent indirect reduction of the posterior column through the ilioinguinal approach, were evaluated clinically and radiographically after a minimum follow-up of one year. The mean follow-up duration was 52.7 months. The reduction quality, clinical results, and radiographic results were analyzed according to the criteria reported by Matta. The complications were also recorded. RESULTS: There were 13 cases (72.2%) of an anatomical reduction, 2 cases (11.1%) of an imperfect reduction, and 3 cases (16.7%) of a poor reduction. Out of 13 anatomically reduced fractures, excellent results were graded in 12 cases clinically and 9 cases radiographically. Poor clinical and radiographic results were graded in 2 of the 3 poorly reduced fractures. Complications included 3 cases with transient lateral femoral cutaneous nerve injury, which resolved during the follow-up period and 1 case with an injury to the superior gluteal artery. CONCLUSION: Indirect reduction of the posterior column through the ilioinguinal approach is effective for both column fractures. During surgery, care should be taken to reduce the risk of iatrogenic lateral femoral cutaneous nerve injury.