Manejo agudo de las fracturas acetabulares mediante artroplastia total de cadera con abordaje anterior / Acute management of acetabular fractures by total hip arthroscopy using an anterior approach

Introducción: Las fracturas acetabulares en pacientes de edad avanzada presentan un reto terapéutico, ya que su osteosíntesis puede estar dificultada por la conminución y la mala calidad ósea. En determinados casos, una buena solución es la artroplastia total de cadera (ATC) aguda por vía anterior directa, con o sin mínima osteosíntesis asociada. El objetivo de este estudio es establecer las indicaciones y valorar los resultados clínico-funcionales, radiológicos y complicaciones, a corto y medio plazo, de la ATC aguda mediante abordaje anterior tras fracturas acetabulares. Material y métodos: Analizamos a 15 pacientes, de los que recogimos: datos demográficos, clasificación de las fracturas, datos quirúrgicos, evaluación clínico-funcional y radiográfica evolutiva, junto con complicaciones perioperatorias. Resultados: El seguimiento medio de los pacientes ha sido de 40 meses con una valoración funcional final de 96,5 para Harris Hip Score y de excelente para Merle D'Aubigné (93%). Los controles radiológicos fueron satisfactorios, sin aflojamientos protésicos. Solo 2pacientes presentaron calcificaciones heterotópicas de bajo grado. El 94% de los pacientes presentó una óptima recuperación posquirúrgica, con carga inmediata. Solo se observó un fallecimiento por causas no relacionadas con la cirugía. Conclusiones: Ante determinadas fracturas acetabulares, la ATC aguda con abordaje anterior directo en decúbito supino y bajo control de escopia con un cotilo de revisión más osteosíntesis mínima asociada, si precisa, nos facilita una adecuada estabilización de la fractura, con recuperación funcional completa del paciente, con carga inmediata, excelentes resultados a corto y medio plazo y mínimas complicaciones

Introduction: Acetabular fractures in elderly patients present a therapeutic challenge, since their osteosynthesis may be hindered by comminution and poor bone quality. In certain cases, a good solution is acute total hip arthroplasty (THA) by direct anterior approach with or without minimal associated osteosynthesis. The objective of this study was to establish the indications and evaluate the clinical/functional, radiological results and complications, in the short and medium term, of acute THA using an anterior approach after acetabular fractures. Material and methods: We analyzed 15 patients collecting: demographic data, classification of fractures, surgical data, clinical/functional and evolutionary radiographic evaluation, together with perioperative complications. Results: The mean follow-up of the patients was 40 months with a final functional assessment of 96.5 for Harris Hip Score, and Merle D'Aubigné excellent in 93%. The radiological controls were satisfactory without prosthetic loosening. Only 2patients presented low-grade heterotopic calcifications. Ninety-four percent of the patients presented optimal postoperative recovery, with immediate loading. There was only one death for reasons unrelated to the surgery. Conclusions: Given certain acetabular fractures, acute THA using a direct anterior approach in the supine position and under scope control with a revision cup plus associated minimal osteosynthesis, if necessary, facilitates adequate fracture stabilization with full functional recovery of the patient with immediate loading and excellent results in the short and medium term with minimal complications

Acute management of acetabular fractures by total hip arthroscopy using an anterior approach. / Manejo agudo de las fracturas acetabulares mediante artroplastia total de cadera con abordaje anterior.

INTRODUCTION: Acetabular fractures in elderly patients present a therapeutic challenge, since their osteosynthesis may be hindered by comminution and poor bone quality. In certain cases, a good solution is acute total hip arthroplasty (THA) by direct anterior approach with or without minimal associated osteosynthesis. The objective of this study was to establish the indications and evaluate the clinical/functional, radiological results and complications, in the short and medium term, of acute THA using an anterior approach after acetabular fractures. MATERIAL AND METHODS: We analyzed 15 patients collecting: demographic data, classification of fractures, surgical data, clinical/functional and evolutionary radiographic evaluation, together with perioperative complications. RESULTS: The mean follow-up of the patients was 40 months with a final functional assessment of 96.5 for Harris Hip Score, and Merle D'Aubigné excellent in 93%. The radiological controls were satisfactory without prosthetic loosening. Only 2patients presented low-grade heterotopic calcifications. Ninety-four percent of the patients presented optimal postoperative recovery, with immediate loading. There was only one death for reasons unrelated to the surgery. CONCLUSIONS: Given certain acetabular fractures, acute THA using a direct anterior approach in the supine position and under scope control with a revision cup plus associated minimal osteosynthesis, if necessary, facilitates adequate fracture stabilization with full functional recovery of the patient with immediate loading and excellent results in the short and medium term with minimal complications.