The use of Verbrugge forceps for reduction of the posterior column element in displaced acetabular fractures: clinical and radiological evaluation.

Abstract

Different reduction techniques and tools are described to facilitate anatomical reduction of acetabular fractures. However, maintenance of reduction, plate placement, and fracture fixation remain a challenge owing to the large surface area occupied by the available reduction tools. This study aims at radiological and functional assessment of the effectiveness of a novel reduction technique for the posterior column element in displaced acetabular fractures. A prospective study was conducted for evaluation of a novel reduction technique; the use of the conventional large holding Verbrugge forceps for reduction of posterior column and transverse, with or without posterior wall, fractures. Intra-operative safety and reduction time were evaluated. The immediate postoperative quality of reduction was assessed using Matta radiographic criteria. The functional outcome was evaluated at the latest follow-up visit using the modified Merle d'Aubigne and Postel (MDP) score. Thirty patients with a mean follow-up of 18.1months were included. Fifteen had transverse/posterior wall, ten had transverse, and five had posterior column fractures. All fractures were displaced ≥ 2mm on anteroposterior and/or Judet views of the pelvis without traction. The average operative time was 100.4min with 12.5min reduction time. No intra-operative complications were encountered. Twenty-three patients (76.6%) had anatomical while seven (23.3%) had imperfect reduction. The functional outcome score was excellent in three patients, good in 18, fair in four, and poor in five patients at the latest follow-up. The use of the conventional large Verbrugge bone-holding forceps for the reduction of the posterior column element in displaced acetabular fractures using the Kocher-Langenbeck approach is a safe, effective, time-saving, and technically undemanding procedure.