[Letournel's ilio-femoral way in acetabular fractures of the two columns. A prospective study].

PURPOSE OF THE STUDY

The authors present the anatomical and functional results of the systematic use of Letournel's extensive lateral approach for internal fixation of the fractures of the acetabulum involving the two columns.

MATERIAL

This prospective study concerns 25 patients. Mean age was 38 years. Mean follow-up was 4 years and 6 months (with extremes of 1 year and 9 years 9 months). 13 cases had a minimum of 4 years of follow-up. There were 1 transversal fracture, 9 transversal fractures associated with a posterior wall fracture, 2 anterior column fractures associated with a hemitransversal posterior fracture, 6 "T" shaped fractures, 7 fractures of the two columns. During the procedure, a trochanterotomy was carried out. Not any of the patients was irradiated postoperatively and they did not take any indomethacin. The patients were operated on 10 days after the accident, on average (with the extremes of 2 and 60 days). The average time of the procedure was 4 H 20 and 1080 cc of globular sediment were used during the intervention on average. The same surgeons participated in each operation.

METHODS

The anatomical results were analysed according to Matta's criteria and the congruence study head-roof and head-acetabulum of the SOFCOT symposium in 1981. The functional results were analysed using the quotation of Merle d'Aubigné. Complications were searched systematically. The appearance of heterotopic ossifications was analysed according to Brooker.

RESULTS

23 patients had a satisfactory anatomical reduction and 11 patients out of 13 did not present any arthrosis after a minimum of 4 years follow-up. 12 patients had very good or good functional results. 3 patients had no heterotopic ossifications, 7 were grade I, 5 grade II, 8 grade III, and 2 grade IV. The gluteus medius was quoted 4 in 18 patients and 5 in 5 patients. There were 2 cases of deep suppuration, one of them was a patient who died 6 months later of a pancreas cancer unrecognized at the time of the accident. There were 5 aseptic osteonecroses and 3 cases of regressive paralysis of the sciatic nerve. 4 total hip prosthesis were inserted secondarily.

DISCUSSION

The Letournel extensive lateral approach was efficient to obtain an anatomical reduction but, functionally, it was only efficient in one case out of two. For the moment, the authors associate systematically a postoperative irradiation to reduce the ossifications (10 to 12 gray in 5 sessions). On the other hand, they try to obtain a more efficient reinsertion of the glutei muscles, thank to a bone fragment of the iliac crest.

CONCLUSION

The authors limit their indications of the Letournel's extensive lateral approach to the fractures of the two columns, not older than 10 days or to the comminuted ones.