Avascular Necrosis of Acetabulum: The Hidden Culprit of Resistant Deep Wound Infection and Failed Fixation of Fracture Acetabulum - A Case Report

Clinical Results of Acetabular Fracture via the Pararectus versus Ilioinguinal Approach

Objective

To compare the clinical efficacy of pararectus and ilioinguinal approach in the treatment of acetabular fractures.

Methods

A retrospective analysis of the clinical data of 60 patients with acetabular fractures treated by the pararectus approach or the ilioinguinal approach from January 2016 to January 2019 was performed to record all data by comparing the length of the surgical incision, the time to expose the fracture and the amount of blood loss during the operation. Patients were routinely followed up at 1, 6 and 12 months postoperatively. The function of the hip joint after the operation (Improved Merle d' Aubigne and Postel scores) and the complications postoperation were recorded.

Results

There was a significant difference (mean ± SD) in the length of surgical incision [(11.2 ± 1.5) cm vs.(23.8 ± 2.1) cm], and in surgical exposure time [(10.8 ± 1.7) min vs.(19.9 ± 1.9) min] (P < 0.05) between the two approaches; there was no significant difference (mean ± SD) in intraoperative blood loss [(591.8 ± 131.4) mL vs. (614.6 ± 132.7) mL] or in hip function scores at the last follow‐up between the two groups (P > 0.05). In the pararectus approach group, there was one patient (3.3%) with postoperative wound fat liquefaction, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics, one patient (3.3%) developed lateral femoral cutaneous nerve injury; One case (3.3%) of postoperative myositis ossificans occurred in the ilioinguinal approach group, and there were no obvious symptoms.

Conclusions

These data suggest that for patients with acetabular fractures, both the pararectus approach and the ilioinguinal approach can achieve satisfactory surgical results, but the former has relatively simple operation and small incision length, which is in line with the modern concept of the minimally invasive pelvis.

Therapeutic Effect of Acetabular Fractures Using the Pararectus Approach Combined with 3D Printing Technique

Objective

To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial acetabular fractures.

Methods

We retrospectively evaluated 33 (20 males and 13 females) patients with acetabular fractures in the period of June 2017 to December 2018. According to Judet and Letournel classification: 11 cases were of anterior column fracture, 10 cases were of double column fracture, seven fractures were of the anterior column with posterior half transverse, three fractures were of transverse fracture, and two cases were of “T” fracture. For all cases, 3D printing is used to print the acetabular model. Pre‐bent reconstruction plates from the model were placed to fixate fractures via the pararectus approach.

Results

Thirty‐three patients (mean age 48 years; range, 35–63 years), included 20 men and 13 women, were treated successfully with open reduction and internal fixation by the pararectus approach. Surgery duration was 203 min on average (range: 135–245 min), and intra‐operative bleeding was 1030 mL on average (range: 450–1400 mL). All patients were followed‐up for 12–18 months (average,14 months); two patients (6.0%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; one patient (3.0%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing, and effective antibiotics; all the acetabular fractures united after 12 to 16 weeks (average,13 weeks). According to the modified Merle d'Aubigne and Postel scoring system to assess the hip function: excellent in 22 cases (66.7%), good in seven cases (21.2%), and fair in four cases (12.1%).

Conclusions

In the treatment of partial acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time, and the internal fixation position can be properly adjusted during the operation by looking directly at the model.