Operative treatment of associated acetabular fractures via a single Kocher-Langenbeck approach

Abstract

To evaluate the operative outcome of associated acetabular fractures through single Kocher-Langenbeck (K-L) approach and investigate the relationship between the quality of fracture reduction and long-term joint function. A total of 116 associated acetabular fractures were treated through single K-L approach at our department from October 1993 to December 2004. All cases were evaluated retrospectively. And 80 cases (81 hips) were followed up, including 5 hips of T-shaped fractures, 53 hips of associated transverse and posterior wall fractures, 18 hips of associated posterior column and posterior wall fractures, 4 hips of both column fractures and 1 hip of the associated anterior and posterior hemitransverse fractures. The quality of fracture reduction was evaluated. And the functional results and complications were tracked. The average duration of follow-up was 51.7 months. Anatomical reduction was achieved in 39, satisfactory in 31 and unsatisfactory reduction in 11 hips. The clinical outcome was excellent and good in 62 (76.5%) hips. All fractures were healed without infection. And 24 hips showed post-operative heterotopic ossification. The incidence of post-traumatic osteoarthritis was 22.5% (18 hips). There were 5 hips with the palsies of sciatic nerve. And the avascular necrosis of femoral head was found in 6 hips. Associated posterior column and posterior wall fractures, most transverse and posterior wall fractures, certain T shape fractures and both column fractures may be treated through a single K-L approach. Excellent reductions and satisfactory functional outcome can be achieved. The satisfactory joint function is based on a perfect fracture reduction.