Digastric Trochantric Flip Osteotomy When and How to do it in Acetabular Fractures ?

Abstract

There comes a time in acetabular fractures-posterior wall and or posterior column fractures when simple Kocher-Langenbeck Approach seems handicapped and you need to have some extension, as in cases of cranial extension of posterior wall fractures and /or need to retrieve loose segments from acetabular joint when with all efforts made by traction, space seems wanting. Kocher-Langenbeck Approach used for posterior and posterior column injuries and also for some T type fractures, gives very little access to intra articular injuries despite a good traction. Gluteus medius tenotomy and Trochantric osteotomy was done earlier [still being done by some ] but of late Digastric Flip Osteotomy is gaining popularity as it is less traumatic and helps saving blood supply and ,thus reduce chances of AVN. The femur head is dislocated anteriorly or posteriorly, without much difficulty and internal status of the joint is observed without having to worry about devascularization of acetabular wall leading to further complications. So to enumerate the need for Digastric Flip Osteotomy in acetabular fractures are- 1.-intra-articular fragments, 2. Impaction of fragments 3. Posterior wall comminution free fragments, 4. Superior acetabular rim or dome fractures, 5. Assessment of the reduction of the anterior Column, and finally 6. Intra-articular assessment of placement of a long screw inserted into the anterior column. Keywords: Digastric flip osteotomy posterior wall, posterior column, intra articular fragments, head dislocation.