Download PDF
CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2020; 61(02): 040-046
DOI: 10.1055/s-0040-1712938
Original Article | Artículo Original

Tratamiento quirúrgico de las fractura de pared posterior de acetábulo. Resultados a corto y mediano plazo

Surgical Treatment in Acetabular Posterior Wall Fractures. Short and Medium-Term Results
Ignacio E. Villalón 
1   Equipo cadera y pelvis Hospital Clínico Mutual de Seguridad, Región Metropolitana, Chile
4   Equipo cadera y pelvis Clínica Alemana de Santiago, Chile
,
Jaime Cancino 
2   Médico cirujano Universidad del Desarrollo, Santiago, Chile
,
Óscar Bravo
3   Residente de Traumatología y Ortopedia, Universidad de Valparaíso, Chile
,
Cristóbal Vigueras
3   Residente de Traumatología y Ortopedia, Universidad de Valparaíso, Chile
,
Julio Piriz
4   Equipo cadera y pelvis Clínica Alemana de Santiago, Chile
,
Javier del Río
1   Equipo cadera y pelvis Hospital Clínico Mutual de Seguridad, Región Metropolitana, Chile
5   Centro de Cadera Clinica Las Condes, Región Metropolitana, Chile
› Author Affiliations
› Further Information
   Permissions and Reprints

Resumen

Objetivo Evaluar los resultados radiológicos a corto y mediano plazo de pacientes operados de fractura de pared posterior de acetábulo, describir la morfología de la fractura, presencia de lesiones asociadas y la necesidad de artroplastia total de cadera (ATC) durante la evolución.

Material y métodos Estudio retrospectivo-descriptivo de una serie consecutiva de 40 pacientes operados entre julio de 2012 y julio de 2017 por fractura de pared posterior de acetábulo. Treinta y siete hombres y tres mujeres con una edad promedio de 41 años fueron operados (mediana de seguimiento 17,7 meses). Se registró el mecanismo del accidente y presencia de lesiones asociadas. Se registraron el número de fragmentos que presentaba la fractura, presencia de impactación marginal, compromiso de la cabeza femoral, presencia de fragmentos intra-articulares y complicaciones postoperatorias. Para el análisis estadístico se utilizó el test de Wilcoxon.

Resultados Todos los casos fueron secundarios a un accidente de alta energía. Un 70% de los pacientes presentó luxación posterior. La mayoría de los pacientes presentó una fractura entre 2 y 5 fragmentos (70%), 47,5% de los pacientes presentó impactación marginal, 37,5% compromiso de la cabeza femoral en zona de carga, 30% fragmentos intra-articulares. La complicación que más frecuente se observó fue la artrosis post-traumática la cual se presentó en un 22,5%. Cinco pacientes (12,5%) requirieron ATC.

Conclusión Aunque se categorizan dentro de los patrones simples, las fracturas de pared posterior son lesiones complejas. La tomografía axial computada preoperatoria es esencial para determinar lesiones intra-articulares dada su alta frecuencia y también permite realizar un buen plan preoperatorio.

Abstract

Objective Evaluate radiologic results in short and medium-term in surgically treated patients with acetabular posterior wall fracture. Describe fracture morphology, the presence of associated lesions and the necessity of total hip arthroplasty (THA) during the evolution.

Materials and methods A retrospective-descriptive study design of 40 patients treated during July 2012 and July 2017 for acetabular posterior wall fracture. 37 men and 3 women, 41 years old mean age. The mean follow-up was 17.7 months. Accident mechanism and presence of associated lesions were registered, as well as the number of fragments of the fracture, the presence of marginal impaction, femoral head compromise, intra-articular fragments and postoperatory complications. Wilcoxon test was used for the statistical analysis.

Results Every case resulted due to a high energy accident. 70% of patients had posterior luxation of the hip. 70% of patients presented 2 to 5 fragments. 47.5% of patients presented marginal impaction, 37.5% compromised femoral head and 30% intra-articular fragments. The most frequent complication was post-traumatic arthrosis, which appeared in 22.5% of patients. Five patients required THA.

Conclusion Though it is categorized as simple fracture pattern, posterior wall fractures are complex. Preoperatory CT scan is essential to determine intra-articular lesions due to its high frequency and permits to plan an adequate intervention.

Palabras clave

Fractura acetábulo - pared posterior - reducción y osteosíntesis

Keywords

Acetabular fracture - posterior wall - reduction and osteosynthesis


Publication History

Received: 16 May 2018

Accepted: 18 April 2020

Article published online:
20 July 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Bibliografía

  • 1 Aho AJ, Isberg UK, Katevuo VK. Acetabular posterior wall fracture. 38 cases followed for 5 years. Acta Orthop Scand 1986; 57 (02) 101-105
    CrossrefPubMedGoogle Scholar
  • 2 Baumgaertner MR. Fractures of the posterior wall of the acetabulum. J Am Acad Orthop Surg 1999; 7 (01) 54-65
    CrossrefPubMedGoogle Scholar
  • 3 Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. New York, NY: Springer; 1993
    CrossrefGoogle Scholar
  • 4 Grimshaw CS, Moed BR. Outcomes of posterior wall fractures of the acetabulum treated nonoperatively after diagnostic screening with dynamic stress examination under anesthesia. J Bone Joint Surg Am 2010; 92 (17) 2792-2800
    CrossrefPubMedGoogle Scholar
  • 5 Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996; 78 (11) 1632-1645
    CrossrefPubMedGoogle Scholar
  • 6 Moed BR, Dickson KF, Kregor PJ, Reilly MC, Vrahas MS. The surgical treatment of acetabular fractures. Instr Course Lect 2010; 59: 481-501
    PubMedGoogle Scholar
  • 7 Mears DC, Velyvis JH. Primary total hip arthroplasty after acetabular fracture. Instr Course Lect 2001; 50: 335-354
    PubMedGoogle Scholar
  • 8 Moed BR, Carr SE, Gruson KI, Watson JT, Craig JG. Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment. J Bone Joint Surg Am 2003; 85 (03) 512-522
    CrossrefPubMedGoogle Scholar
  • 9 Siebenrock KA, Gautier E, Ziran BH, Ganz R. Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach. J Orthop Trauma 1998; 12 (06) 387-391
    CrossrefPubMedGoogle Scholar
  • 10 Mitsionis GI, Lykissas MG, Motsis E. , et al. Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: a study with a minimum follow-up of 15 years. J Orthop Trauma 2012; 26 (08) 460-465
    CrossrefPubMedGoogle Scholar
  • 11 Rath EM, Russell Jr GV, Washington WJ, Routt Jr ML. Gluteus minimus necrotic muscle debridement diminishes heterotopic ossification after acetabular fracture fixation. Injury 2002; 33 (09) 751-756
    CrossrefPubMedGoogle Scholar
  • 12 Ebraheim NA, Patil V, Liu J, Sanford Jr CG, Haman SP. Reconstruction of comminuted posterior wall fractures using the buttress technique: a review of 32 fractures. Int Orthop 2007; 31 (05) 671-675
    CrossrefPubMedGoogle Scholar
  • 13 Moed BR, WillsonCarr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am 2002; 84 (05) 752-758
    CrossrefPubMedGoogle Scholar
  • 14 Saterbak AM, Marsh JL, Nepola JV, Brandser EA, Turbett T. Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma 2000; 14 (04) 230-237
    CrossrefPubMedGoogle Scholar
  • 15 Bogdan Y, Tornetta III P, Jones C. , et al. Neurologic injury in operatively treated acetabular fractures. J Orthop Trauma 2015; 29 (10) 475-478
    CrossrefPubMedGoogle Scholar
  • 16 Magu NK, Gogna P, Singh A. , et al. Long term results after surgical management of posterior wall acetabular fractures. J Orthop Traumatol 2014; 15 (03) 173-179
    CrossrefPubMedGoogle Scholar
  • 17 Alonso JE, Volgas DA, Giordano V, Stannard JP. A review of the treatment of hip dislocations associated with acetabular fractures. Clin Orthop Relat Res 2000; (377) 32-43
    CrossrefPubMedGoogle Scholar
  • 18 Giannoudis PV, Kanakaris NK, Delli Sante E, Morell DJ, Stengel D, Prevezas N. Acetabular fractures with marginal impaction: mid-term results. Bone Joint J 2013; 95-B (02) 230-238
    CrossrefPubMedGoogle Scholar
  • 19 Martins e Souza P, Giordano V, Goldsztajn F, Siciliano AA, Grizendi JA, Dias MV. Marginal impaction in posterior wall fractures of the acetabulum. AJR Am J Roentgenol 2015; 204 (04) W470-4
    CrossrefPubMedGoogle Scholar
  • 20 Cahueque M, Martínez M, Cobar A, Bregni M. Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?. J Clin Orthop Trauma 2017; 8 (04) 320-326
    CrossrefPubMedGoogle Scholar
  • 21 Pascarella R, Cerbasi S, Politano R. , et al. Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture. Injury 2017; 48 (08) 1819-1824
    CrossrefPubMedGoogle Scholar