Arthroscopic Management of Intraarticular Screw Perforation after Surgical Treatment of an Acetabular Posterior Wall Fracture: A Case Report

Arthroscopic Reduction and Internal Fixation in Patients with Acetabular Posterior Wall Fractures

Background

This study aimed to access the radiologic and clinical outcomes after arthroscopic reduction and internal fixation with screws in patients with posterior wall fractures of the acetabulum.

Methods

From May 2013 to December 2019, 13 patients (11 men and 2 women) with posterior wall fractures of the acetabulum were treated with arthroscopic reduction and internal fixation with screws at two medical centers. The mean age at the index operation was 39 years (range, 22-58 years). The mean duration of follow-up was 23 months (range, 12-46 months). Clinical assessment was performed using the modified Merle d'Aubigné and Postel functional scoring system. The maximum displacement of acetabular or femoral head fragments detected on radiographs was used as radiographic results. Secondary osteoarthritis, osteonecrosis, or heterotrophic ossification was assessed at the latest follow-up.

Results

Bony union was shown at 12 weeks of follow-up in all patients. The radiologic outcomes showed an anatomical reduction in 11 patients and a satisfactory reduction in 2 patients. The modified Merle d'Aubigné and Postel functional score was excellent in 7 patients, good in 5 patients, and fair in 1 patient. Two patients had transient pudendal nerve palsy after hip arthroscopy. However, no sciatic nerve palsy occurred. At the latest follow-up, there was no heterotopic ossification, osteonecrosis of the femoral head, or posttraumatic osteoarthritis.

Conclusions

Arthroscopic reduction and internal fixation with cannulated screws can be good alternative options with good radiographic and clinical outcomes, convenient removal of intra-articular loose body, and low complication rates.

Surgical Treatment of Acetabular Posterior Wall Fracture with Hip Arthroscopy: A Case Report

Posterior wall fractures are the most common type of acetabular fractures. Treatment can be conservative or surgical. Operative treatment is indicated for acetabular fractures that result in hip joint instability and/or incongruity, as well injuries with incarceration of fragments of bone or soft tissue within the hip joint. Surgical treatment can range from open reduction and osteosynthesis to hip arthroplasty. Arthroscopy has recently been used as the main surgical technique or as a reduction aid. In this case a 26-year-old male with a fracture of the posterior wall who underwent a posterior miniinvasive approach, followed by hip arthroscopy. This allowed joint wash, removal of the loose body, confirmation of reduction and absence of intra-articular hardware. Excellent clinical and radiological results were obtained. This case demonstrates the advantage of using hip arthroscopy in assessment of fracture reduction, the absence of intra-articular hardware or fragments, as well as a less invasive approach.

Arthroscopic removal of an intra-articular screw causing joint impingement after distal femoral fracture repair in a dog

The use of lag screws to treat femoral condyle fractures is common, and their placement in surgery is technically demanding. Intra-articular screw impingement is a serious complication that may occur during surgical treatment of femoral condyle fractures. Here, we describe the case of a 3-year-old 40-kg dog which experienced recurrent lameness 6 mo after successful surgical treatment of a comminuted medial femoral condyle fracture due to an intra-articular non-loosening screw causing joint impingement. Removal of the conflicting screw was performed arthroscopically, based on its ability to offer minimally invasive access to the stifle joint. Six months after removal of the screw, the dog had full recovery without limitations to range of motion or stifle pain. To our knowledge, this is the first report on the use of arthroscopy to remove an intra-articular screw causing joint impingement after distal femoral fracture repair in a dog.

Outcomes of Surgical Management of Acetabular Fractures Treated with Anterior Approaches

Objective

In this study we aimed to evaluate the outcomes of anterior and combined approaches for treatment of acetabular fractures.

Materials and Methods

Thirty-seven acetabular fractures in 35 patients treated with an anterior approach were evaluated retrospectively. Fractures were classified according to Judet-Letournel. Early and final radiological evaluation was based on Matta's criteria. Modified Merle d'Aubigne and Postel criteria were used for functional assessment.

Results

Eleven (30%) fractures were simple type and 26 (70%) were mixed type. Two (18%) of the simple fractures were transverse and 9(82%) were anterior column fractures. Fourteen (54%) of the mixed type fractures were both column fractures, 5 (19%) were transverse+posterior wall, 5 (19%) were T shaped and 2 (8%) were anterior column+posterior hemitransverse fractures. Surgical approach was ilioinguinal in 15 (43%) patients, Stoppa in 9 (26%) and combined11 (31%). Our functional outcomes were perfect in 10 (27%) hips, good in 20 (54%), moderate in 4 (10%) and poor in 3 (8%). Our radiological results were perfect in 15 (40.5%) hips, good in 15 (40.5%), moderate in 4 (11%) and poor in 3 (8%).

Conclusion

Anterior surgical approaches provide satisfactory outcomes in appropriate fracture types. Posterior approach can be combined in certain fracture types. We think that rate of the requirement for a concomitant posterior approach for certain fractures of the acetabulum will decrease as experience increases.