External rotator sparing with posterior acetabular fracture surgery: does it change outcome?

Posterior approaches to the acetabulum

Posterior approaches, particularly the Kocher-Langenbeck approach, remain the workhorses in the treatment of acetabular fractures. Various modifications have been developed, each offering specific advantages depending on surgical requirements. The modified Gibson approach, for example, is suggested to provide enhanced visualization of the superior acetabulum, although recent cadaveric studies have not consistently substantiated this benefit. The Ganz approach, which involves bigastric trochanteric osteotomy with safe surgical hip dislocation, is particularly advantageous for managing complex and comminuted posterior acetabular fractures, as it enables a 360° view of the acetabulum and femoral head. Overall, posterior approaches are associated with low rates of complications, with heterotopic ossification being the most prevalent. The choice of surgical approach and patient positioning should be guided by the surgeon's preference and expertise, tailored to the specific fracture pattern and patient characteristics.

Clinical and functional outcomes of posterior wall fractures of the acetabulum fixed with spring plates by a posterolateral rotator-sparing approach

BACKGROUND

Posterior wall fractures are the most frequent and account for up to 25% of all acetabular fractures, open reduction and internal fixation by a Kocher Langenbeck approach is the gold standard for this injury but even with anatomic reduction poor outcomes are higher than expected, The present study proposes a technique for open reduction and internal minimizing soft tissue and periosteal injury through a modified Kocher-Langenbeck and spring plate fixation.

METHODS

This case series, descriptive, longitudinal study assessed the clinical and functional outcomes of patients with isolated posterior wall fractures of the acetabulum, the study included 24 consecutive patients from January to December 2018 who underwent open reduction and internal fixation with spring plates by a Rotator Sparing Kocher Langenbeck approach RESULTS: Clinical and radiographic assessment at 3 and 12 months using the Harris Hip Score (HHS), Merle d'Aubigné and Postel (MDP) score, and EQ-5D-3L score.

RESULTS

Twenty-four patients were included in the study (5 females [20.8%], 19 males [79.2%]; mean age, 33.5 ± 13.1 years; range: 15-64 years). 41.7% of patients were admitted for hip dislocation, with 75% of these presenting a displacement greater than 20 mm; 21% for marginal impaction; 8.3% for acetabular dome involvement; and 25% for femoral head involvement. Based on the HHS, MDP, and EQ-5D-3L scores, the 12-month follow-up showed excellent outcomes in 95.8% of patients, and only one patient presented a poor functional outcome that was associated with posttraumatic arthrosis due to sequelae of femoral head necrosis.

CONCLUSIONS

Excellent and good outcomes are considerably higher with this technique compared to previous papers in the literature. It is still early to assess femoral head necrosis and osteoarthritis, but these are promising results.

LEVEL OF EVIDENCE

IV.