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The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study

Objective

Transverse-oriented acetabular fractures (TOAFs), including transverse, transverse with posterior wall and T-shaped fractures, are always challenging for double-column reduction and fixation with minimally invasive method. The purpose of this study is to compare the therapeutic effects of robot-aided percutaneous anterior column screw fixation versus minimally invasive anterior plate fixation for TOAFs based on the Kocher-Langenbeck (K-L) approach.

Methods

Patients suffering TOAFs that were fixed by robot-aided percutaneous anterior column screw fixation or minimally invasive anterior plate fixation associated with posterior fixation via the K-L approach were divided into two groups: group A (screw fixation) and group B (plate fixation). Surgical time, blood loss, incision length for anterior fixation and complications were recorded. Fracture reduction quality was evaluated using criteria described by Matta. Fracture healing was assessed on the series of pelvic radiographs at each follow-up. Functional outcomes were investigated using the modified Postel Merle D’Aubigne score at the final follow-up.

Results

Twenty-nine patients with TOAFs, including 12 patients in group A and 17 patients in group B, were evaluated for study eligibility. The mean surgical time of anterior fracture fixation was 18.7 ± 4.6 min in group A and 33.4 ± 5.0 min in group B (P < 0.001). The amount of intraoperative blood loss was 615.6 ± 178.7 ml in group A and 719.3 ± 199.0 ml in group B (P < 0.001). Incision length for anterior fixation was 9.0 ± 1.8 mm in group A and 81.2 ± 7.3 mm in group B (P < 0.001). The complications related to the surgery of anterior column only occurred in group B (lateral femoral cutaneous nerve palsy in 1 patient and groin discomfort in 1 patient). No significant differences in reduction quality, hospital stay, fracture healing time and functional results were noted between the two groups.

Conclusion

The K-L approach combined with robot-aided anterior column screw fixation is a safe and effective option for TOAFs. Compared with minimally invasive anterior plate fixation, robot-aided screw fixation has obvious advantages on surgical time, blood loss, and invasiveness. The K-L approach combined with minimally invasive anterior plate fixation can also be a reliable alternative for TOAFs, with the similar reduction quality and functional results.

Shoulder joint position sense after thermal, open, and arthroscopic capsulorrhaphy for recurrent anterior instability

Identifying the optimal surgical treatment for recurrent, anterior glenohumeral instability remains a challenge. Our purpose was to compare shoulder joint position sense among open, arthroscopic, and thermal capsulorrhaphy patients after repair of recurrent anterior instability and to compare these patients to healthy, control subjects. Sixty-seven adults (45 post-surgical patients, 22 controls) volunteered to participate in the study. We evaluated both the surgically repaired and contralateral shoulders of 45 capsulorrhaphy patients (28 men, 17 women) and compared their results with the normal bilateral shoulders of 22 age-matched controls (11 men, 11 women). Accuracy of joint position sense was quantified via passive reproduction of target positions set at 60% and 90% of each subject's maximum passive external rotation (ER(max)). We observed no significant differences in joint position sense between the repaired shoulders and the contralateral normal shoulders of all groups of capsulorrhaphy patients. Open and thermal capsulorrhaphy patients demonstrated significantly better (P </= .05) repaired-limb joint position sense (5.4 degrees +/- 3.3 degrees and 5.6 degrees +/- 3.3 degrees , respectively) than arthroscopic patients (9.2 degrees +/- 3.7 degrees ) and control subjects (8.1 degrees +/- 4.0 degrees ). These results indicate that joint position sense was similar in the repaired shoulders and uninjured shoulders of each group of capsulorrhaphy patients. The mechanism responsible for heightened position sense in open and thermal capsulorrhaphy patients is unknown, but may result from capsular retensioning and muscular scarring. The long-term implications of this outcome deserve further attention.