Does digastric trochanteric flip osteotomy increase complications in treatment of complex acetabular fractures? / 中华创伤骨科杂志

ABSTRACT

Objective To observe the short-,mid-and long-term surgical complications of complex acetabular fractures treated by the Kocher-Langenbeck (K-L) approach combined with digastric trochanteric flip osteotomy (DTFO).Methods We reviewed the 40 cases of complex acetabular fracture that were treated at our department from December 2009 through December 2013.They were 34 men and 6 women,from 17 to 73 years of age (average,47.6 years).Of them,19 were treated by K-L approach combined with DTFO,including 17 males and 2 females,with a mean age of 44.7 ± 11.7 years.The other 21 controls were treated simply through the K-L approach,including 17 males and 4 females,with a mean age of 42.8 ± 14.4 years.The 2 groups were compared in terms of intraoperative results,postoperative outcomes and surgical complications like infection,sciatic nerve injury,heterotopic ossification,femoral avascular necrosis,and post-traumatic arthritis.Results The 40 cases were followed up for an average of 29.7 months (range,from 18 to 59 months).The operation time for the DTFO group (248.2 ± 123.2 min) was significantly shorter than that for the control group (276.1 ±50.6 min),the satisfactory reduction rate for the DTFO group (100.0％) was significantly higher than that for the control group (90.5％),the hip intorsion (19.7° ± 3.5°),hip extorsion (26.1° ±4.3°),and hip abduction (40.5° ±4.7°) at one year postoperation in the DTFO group were significantly superior to those in the control group (14.3°± 6.0°,21.0°± 7.2°,31.9°± 10.8°,respectively),and the hospital stay for the for the DTFO group (19.0 ±7.1 d) was significantly longer than that for the control group (13.6 ±4.9 d) (P ＜ 0.05).The intraoperative bleeding and transfusion for the DTFO group were insignificantly greater than those for the control group (P ＞ 0.05).Infection or iatrogenic sciatic nerve injury occurred in none of the patients.There were no significant differences between the 2 groups in terms of positive Trendelenburg test,hip function,heterotopic ossification,femoral avascular necrosis,or post-traumatic arthritis at the last follow-ups(P＞ 0.05).Conclusions In the surgical treatment of complex acetabular fractures,especially those involving the acetabular dome area and the femoral head,K-L approach combined with DTFO can obtain larger surgical exposure field,good fracture reduction and functional recovery,without obviously increasing surgical complications.This technique only slightly increases intraoperative bleeding and transfusion,and results in longer hospital stay.