Kasha Srinivas, Yalamanchili Ranjith Kumar
Krishna Institute of Medical Sciences, Hyderabad, India.
Orthopaedics, ESIC Medical College, Hyderabad, India.
J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1025-1030. doi: 10.1016/j.jcot.2020.09.018. Epub 2020 Sep 18.
Acetabular impaction fractures when not adequately addressed leads to early arthritis. Dome impaction injuries and marginal impaction injuries have to be properly planned pre-operatively with respect to surgical approach, disimpaction techniques and fixation strategies. CT scan is the best modality to analyse the site, extent of impaction and plan strategies to reduce. Emphasis of early mobilisation should not drive the surgeon towards the motive of rigid fixation of columns alone, as the inadequate reduction of acetabular impaction leads to loss of mechanical support on weight bearing and thereby cause loss of reduction. Bone grafting either by auto or allograft or graft substitutes in the void after disimpaction helps in reducing anatomically and provide mechanical support adequately. In cases of severe comminution, reconstruction of the wall defect with autologous graft is a better treatment option. In this article we reviewed the characteristics of impaction injuries of acetabulum exploring surgical procedures, approaches and techniques for achieving open reduction and internal fixation.
髋臼撞击骨折若未得到充分处理会导致早期关节炎。对于穹顶撞击伤和边缘撞击伤，必须在术前就手术入路、去撞击技术和固定策略进行妥善规划。CT扫描是分析撞击部位、范围并制定复位策略的最佳方式。早期活动的重点不应使外科医生仅倾向于对柱进行坚强固定，因为髋臼撞击复位不充分会导致负重时机械支撑丧失，进而导致复位丢失。去撞击后在骨缺损处采用自体骨移植、异体骨移植或骨移植替代物有助于实现解剖复位并提供足够的机械支撑。在严重粉碎的情况下，用自体骨移植重建壁缺损是更好的治疗选择。在本文中，我们回顾了髋臼撞击伤的特点，探讨了实现切开复位内固定的手术方法、入路和技术。
