The characteristic and treatment of high anterior column fracture of acetabulum with intact true pelvic brim / 中华骨科杂志

ABSTRACT

ObjectiveTo investigate the results of open reduction with internal fixation for high anterior column fracture of acetabulum with intact true pelvic brim.MethodsFrom January 2006 to January 2010,12 patients suffered high anterior column fracture of acetabulum without involvement of true pelvic brim were identified.There were 9 males and 3 females,with the average of 35.6 years(range,29-46).The injury was caused by crush in 7 cases,smash of heavy object in 3 cases,and fall-down from height in 2 cases.These fractures were classified into three typesisolated high anterior column fracture of acetabulum without involvement of true pelvic brim,high anterior column fracture of acetabulum without involvement of true pelvic brim with posterior wall fracture of acetabulum and commminuted high anterior column fracture of acetabulum without involvement of true pelvic brim according to present and unpresent of posterior wall fracture.Five cases suffered isolated fracture and 2 cases associated smaller and nondisplacement fracture fragment of posterior wall were reduced and fixed by buttress plate of iliac crest and lag screw of anterior border of ilium through an iliofemoral approach; 4 cases with displacement posterior wall fracture of acetabulum were reduced and reconstructed by buttress plate and lag screws of through combinations of anterior and posterior approaches.One case suffered comminuted fracture were reduced and reconstructed by plates and screws of through extended iliofemoral approach.ResultsThe mean follow-up time of all patients was 26.7 months (range,14-37months).The quality of reduction was grade as anatomical in 8 patients,imperfect in 3,poor in 1 by Matta's score system.The fracture union was uneventful.There was nonunion and loss of internal fixation.At the final follow-up,the mean score was 16.8 (range,11-18),7 cases were graded as excellent,4 good,1 fair,according to modified Merle d'Aubigne and Postel score system.Heterotopic ossification and traumatic osteoarthritis were recorded in 1 patient.ConclusionGood clinical results can be achieved by anatomical reduction and rigid fixation through optimal approach.