Abstract

PurposeThis study aims to examine the clinical efficacy and surgical techniques of the lateral-rectus approach for treatment of acetabular factures in elderly patients.MethodsAfter appropriate exclusion, 65 elderly patients with an acetabular fracture who was treated through the lateral-rectus approach from January 2011 and October 2016 were selected retrospectively. By analyzing the medical records retrospectively, the patients’ characteristics, fracture type, mechanism of injury, comorbid conditions, ASA class, operative time, intra-operative blood loss, and post-operative complications were assessed. Clinical examination radiographs have been taken, align with the Matta evaluation system. Functional outcomes were evaluated using surveys including SF-36, Harris hip score, and modified Merle D’Aubigne-Postel.ResultsAll 65 patients had undergone the single lateral-rectus approach successfully. Surgery duration was 101.23 min on average (45–210), and intra-operative bleeding was 798.46 ml on average (250–1800). According to the Matta radiological evaluation, the quality of reduction evaluated 1 week after surgery was rated as “anatomical” in 41 (63.1%) cases, “imperfect” in 12 (18.5%) cases, and “poor” in 12 (18.5%) cases. The modified Merle D’Aubigne-Postel score performed 18 months after surgery was categorized as excellent in 40 (61.5%) cases, good in 10 (15.4%) cases, and fair in 15 (23.1%) cases. The mean Harris Hip score was similar as present researches, being 87.18. The mean SF-36 score was 69.12 which was considered as normal for the group age 60 and older. Several complications were found, including screw loosening in 10 cases, fat liquefaction of incision in 2 cases, deep vein thrombosis in 2 cases, and temporary weakness of hip adductors in 5 cases. None of the patients had heterotopic ossification.ConclusionsThe lateral-rectus approach is a valuable alternative to the ilioinguinal and modified Stoppa approach, being the treatment of acetabular fractures in elderly patients.

Highlights

  • Acetabular fracture is an intra-articular fracture existing in the most important weight-bearing joints of humankind, and as a result, open reduction and rigid internal fixation of the displaced fracture fragments in time will lead to a better outcome than conservative treatment proposed by Judt et al in the 1960s [1]

  • Diverse traditional surgical approaches are used for surgery treatment of the acetabular fractures and they are categorized into anterior, posterior (Kocher-Langenbeck approach), and combined approach

  • Because the ilioinguinal approach can provide a wide view of the anterior column and the inner surface of the posterior column, it is the “gold standard” for the treatment of acetabular fractures in elderly patients

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Summary

Introduction

Acetabular fracture is an intra-articular fracture existing in the most important weight-bearing joints of humankind, and as a result, open reduction and rigid internal fixation of the displaced fracture fragments in time will lead to a better outcome than conservative treatment proposed by Judt et al in the 1960s [1]. Because the ilioinguinal approach can provide a wide view of the anterior column and the inner surface of the posterior column, it is the “gold standard” for the treatment of acetabular fractures in elderly patients. The lateral-rectus approach, a novel anterior approach which provides adequate exposure of the anterior columns, the quadrilateral plate and the inner surface of posterior column with the less injury, is used for the complicated acetabular fractures in adults [9, 10]. It may be a better choice for the elderly patients suffering acetabular fractures

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