Dunlap Burton D, Voskuil Ryan T, Cincere Brandon, Nowotarski Peter J
The University of Tennessee College of Medicine Chattanooga, Department of Orthopaedic Surgery, 975 E. Third St., Hospital Box 260, Chattanooga, TN 37403, United States of America.
Trauma Case Rep. 2019 Jun 28;22:100215. doi: 10.1016/j.tcr.2019.100215. eCollection 2019 Aug.
Acetabular fractures are injuries that require significant force transmission, especially when associated with a femoral head dislocation. The mechanism of injury is typically in the setting of a high-speed motor vehicle collision. In a similar manner, this is an injury that is highly demanding for the orthopaedic trauma surgeon to treat as well. We present a patient who sustained an initial posterior wall acetabular fracture with an associated posterior dislocation. This was treated surgically with open reduction, internal fixation without complication. The patient subsequently sustained a second posterior wall acetabular fracture with dislocation fifteen years later through the plated and healed previous fracture. Both injuries were sustained in high-speed motor vehicle collisions, so it is difficult to presume the patient was predisposed for the repeat injury. At any rate, the repeat injury makes the surgical management significantly more challenging. In complicated acetabular fractures like these, a post or intra-operative CT scan can be of utility to determine quality of reduction as well as assessing for retained bony fragments. Our patient underwent a post-operative CT scan with the finding of intra-articular bony fragments that subsequently required arthroscopic removal. Given the rare nature of this complicated injury occurring twice in a patient, it is difficult to make evidence-based comments on long-term prognosis and functional outcomes. This unique case and the applied treatment will serve as a guide for future similar cases.
髋臼骨折是需要巨大力量传导的损伤，尤其是与股骨头脱位相关时。损伤机制通常发生在高速机动车碰撞的情况下。同样，这种损伤对于骨科创伤外科医生来说也是极具挑战性的治疗对象。我们介绍一位患者，其最初发生后壁髋臼骨折并伴有后脱位。通过切开复位、内固定进行手术治疗，未出现并发症。该患者随后在15年后，通过已钢板固定且愈合的先前骨折处再次发生后壁髋臼骨折并脱位。两次损伤均发生在高速机动车碰撞中，因此很难推测患者易发生再次损伤。无论如何，再次损伤使手术治疗的难度显著增加。在像这样的复杂髋臼骨折中，术后或术中CT扫描有助于确定复位质量以及评估是否有残留骨碎片。我们的患者接受了术后CT扫描，发现关节内有骨碎片，随后需要通过关节镜取出。鉴于这种复杂损伤在一名患者身上发生两次的罕见性，很难对长期预后和功能结果做出基于证据的评论。这个独特的病例及所采用的治疗方法将为未来类似病例提供指导。
