Caviglia Horacio, Mejail Adrian, Landro Maria Eulalia, Vatani Nosratolah
Department of Orthopaedic Surgery and Traumatology, Dr. Juan A. Fernández General Hospital, Argentina.
EFORT Open Rev. 2018 May 21;3(5):326-334. doi: 10.1302/2058-5241.3.170054. eCollection 2018 May.
The objective of surgery for acetabular fractures is to achieve precise reduction to restore joint congruence, fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation.Open reduction and internal fixation is the benchmark method for displaced acetabular fractures, but open reductions can increase morbidity, causing neurovascular injury, blood loss, heterotopic bone formation, infection and poor wound healing.An anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis.The percutaneous approach is associated with fewer complications than open techniques, but acetabular geometry makes percutaneous screw insertion a challenging procedure.The percutaneous technique is recommended for non-displaced or slightly displaced fractures, and in obese, osteoporotic and elderly patients who cannot receive total joint arthroplasty.We recommend the use of intramedullary cannulated screws.Fracture reductions are achieved by manual traction of the affected bones. If some fracture displacement remains, accessory windows can be used to introduce a ball spike pusher, a hook or a Steinmann pin which can be used as a joystick to rotate the fracture.In this paper, we describe the accessory windows for the anterior column, the quadrilateral plate and the posterior column. We detail the position, direction and kind of screws used to stabilize the anterior and posterior columns. Cite this article: 2018;3 DOI: 10.1302/2058-5241.3.170054.
髋臼骨折手术的目的是实现精确复位以恢复关节的一致性，固定内部骨碎片，避免骨折移位并促进快速康复。切开复位内固定是移位髋臼骨折的标准方法，但切开复位会增加发病率，导致神经血管损伤、失血、异位骨形成、感染及伤口愈合不良。间隙小于或等于2 mm的解剖复位是关节功能良好及创伤后骨关节炎风险降低的预测指标。与切开技术相比，经皮入路的并发症更少，但髋臼的解剖结构使经皮螺钉置入成为一项具有挑战性的操作。对于无移位或轻度移位骨折以及无法接受全关节置换术的肥胖、骨质疏松和老年患者，推荐采用经皮技术。我们建议使用髓内空心螺钉。通过对患骨进行手动牵引实现骨折复位。如果仍存在一些骨折移位，可使用辅助窗口插入球头钉推压器、钩子或斯氏针，这些工具可作为操纵杆来旋转骨折部位。在本文中，我们描述了前柱、四边形板和后柱的辅助窗口。我们详细介绍了用于稳定前柱和后柱的螺钉的位置、方向和类型。引用本文：2018;3 DOI: 10.1302/2058-5241.3.170054。
