Il trattamento delle fratture dell'acetabolo con lussazione chirurgica

Background: The technique of surgical hip dislocation allows for a 360 degree view of the acetabulum and may facilitate anatomic reduction of anterior and posterior column fractures, thus avoiding combined or extensile approaches.
 Description of Technique: To our knowledge there is no description in the literature of the different techniques used to reduce T-type fractures, transverse fractures alone and transverse fractures associated with posterior wall fractures using this approach.
 Methods: The first consecutive 31 fractures treated by a single pelvic trauma centre were retrospectively reviewed. Criteria of exclusion were a concomitant femoral head fracture and a follow-up shorter than 8 months. Patient age at surgery, gender, laterality, operative time and blood loss and post-operative complications were recorded in a custom-made database. Outcomes were evaluated with Merle D'Aubigne¿Postel scoring system. Radiological outcome was scored according to Matta's criteria with use of the post-operative radiographs.
 Results: The mean surgical time was 203 minutes. Surgical reduction of the anterior column was defined as anatomic in 67% cases, imperfect in 30%and poor in 13% of cases; posterior column reduction was classified as anatomic in 96% of cases and imperfect in 4% of cases.
Mean follow-up was 40 months. The mean Merle D'aubigné and Postel score was 15 points. Two patients developed avascular necrosis of the femoral head.
 Discussion: The rate of avascular necrosis is comparable with or inferior to those previously reported in the literature using the standard Kocher-Langhebeck approach. Surgical dislocation presents several advantages: single approach reducing surgical time and soft tissue lesions, direct intra-articular assessment, screw placement closer to the articular surface, debridement of gluteus minimus muscle. On the other hand, this technique presents several limitations: challenging anterior column reduction when the anterior rim of the fracture is medial to the ilio-pubic eminence, suboptimal view of the lower extra-articular part of the anterior column, limited reducing clamp positioning, limited fixation of the anterior column, risk of greater trochanter malunion, demanding surgical steps.