Intraoperative Acetabular Fracture

Abstract

Intraoperative acetabular fracture is a rare complication in total hip arthroplasty. It occurs mainly as a result of impaction of a cementless press-fit cup. Risk factors include decreased bone quality, highly sclerotic bone, and a press-fit that was relatively too large. The timing of the diagnosis determines the therapeutic approach. Fractures detected intraoperatively should be treated with appropriate stabilisation. Postoperatively, the stability of the implants as well as the fracture pattern determine whether a conservative treatment is initially feasible. Most acetabular fractures diagnosed intraoperatively are to be treated with a multi-hole cup, with additional screws anchoring in the different acetabular regions. In cases of large posterior wall fragments or pelvic discontinuity, plate osteosynthesis of the posterior column is indicated. Alternatively, cup-cage reconstruction can be utilised. Especially in elderly patients, the therapeutic goal must be rapid mobilisation through adequate primary stability, in order to minimise the risk of complications, revision, and mortality.

Zusammenfassung

Die intraoperative Azetabulumfraktur ist eine seltene Komplikation in der Hüfttotalendoprothetik. Sie tritt hauptsächlich als Folge der Impaktion einer zementfreien Press-fit-Pfanne auf. Risikofaktoren sind eine verminderte Knochenqualität, ein stark sklerotischer Knochen und ein zu groß gewähltes Press-fit. Der Zeitpunkt der Diagnose bestimmt das therapeutische Vorgehen. Intraoperativ erfasste Frakturen sollten immer mit einer entsprechenden Stabilisierung behandelt werden. Postoperativ entscheidet die Stabilität der Implantate sowie der Fraktur darüber, ob zunächst ein konservatives Behandlungsprozedere möglich ist. Die meisten intraoperativ diagnostizierten Azetabulumfrakturen sind mit einer Multi-Hole-Pfanne mit zusätzlichen in den unterschiedlichen Azetabulumregionen verankernden Schrauben zu versorgen. Bei großen Hinterwandfragmenten oder einer Beckendiskontinuität ist primär eine Plattenosteosynthese des hinteren Pfeilers indiziert. Alternativ kann eine Cup-Cage-Rekonstruktion zur Anwendung kommen. Insbesondere beim älteren Patienten muss das Therapieziel die schnelle Mobilisierung durch eine adäquate Primärstabilität sein, um das Komplikations-, Revisions- und Mortalitätsrisiko auf ein Minimum zu reduzieren.

Keywords

total hip arthroplasty - complications - intraoperative acetabular fracture - periprosthetic fracture - cup revision

Schlüsselwörter

Hüfttotalendoprothese - Komplikationen - intraoperative Azetabulumfraktur - periprothetische Fraktur - Pfannenrevision

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