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

Ceylan H, Selek O, Inanir M, Yonga O, Odabas Ozgur B, Sarlak AY - Adv Orthop (2014)

Bottom Line: The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta.The greatest loss of strength was in internal rotation.Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Akademi Hospital, 41300 Kocaeli, Turkey.

ABSTRACT
This study analyses the results of the treatment with external rotator sparing approach in acetabular fractures to determine whether muscle sparing has a positive impact on functional outcome. 20 patients with a mean age of 45.9 years (range: 26-64) that had been treated for displaced acetabular fractures were included in this series. Short Musculoskeletal Function Assessment (SMFA) questionnaire and hip muscle strength measurement were done at the 24-month of follow-up period. The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta. The average SMFA score for all of the patients was 18.3 (range: 0-55.4). The mean dysfunctional and bother indexes were 17.2 and 20.6, respectively. The overall muscle strength deficit was 11.8%. The greatest loss of strength was in internal rotation. In patients with better postoperative reduction quality of acetabular fracture, peak torque, and maximum work of hip flexion, extension and also internal rotation maximum work deficit were significantly lower (P < 0.05). Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures.

No MeSH data available.


Related in: MedlinePlus

A 26-year-old male patient having acetabular fracture. (a) Preoperative X-Ray. (b) Preoperative 3D-CT scan. (c) Early postoperative X-Ray. (d) Late postoperative X-Ray (24 months).
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fig1: A 26-year-old male patient having acetabular fracture. (a) Preoperative X-Ray. (b) Preoperative 3D-CT scan. (c) Early postoperative X-Ray. (d) Late postoperative X-Ray (24 months).

Mentions: The patients were placed in a prone position on the radiolucent normal operating table under general anesthesia. An incision beginning a handbreadth superior to posterior superior iliac spine on the iliac crest advancing laterally to the greater trochanter and then curving posteriorly towards the gluteal fold was used. Gluteus maximus origin was not detached from the iliac crest; the plane between tensor fascia lata and gluteus maximus was used to reflect the gluteus maximus posteriorly. Distal part of the gluteus maximus insertion to femur was not divided. Then gluteus maximus was reflected posteriorly to provide exposure of the entire posterior pelvis and direct visualization of the sciatic nerve. Working in the superficial plane to external hip rotators, fracture site and when necessary the joint capsule were exposed between either gluteus medius and piriformis or piriformis and superior gemellus interval (superior portal). There was short external rotator muscle damage in the patients with hip dislocation in variable degrees. But at least the quadratus femoris and gemellus inferior muscles were intact in all patients with hip dislocation. The interval between the sciatic nerve and posterior cutaneous nerve of the thigh gives direct access to ischium. Releasing the semimembranosus origin and medial retraction of biceps femoris origin, the posterolateral wall of ischium was reached. Bending template was used for plate contouring. In most fractures gentle retraction of the gluteus medius to widen the superior portal is sufficient to reduce the displaced posterior fragment gently compressing it with a periosteal elevator. A curved 3.5 mm or 4.5 mm reconstruction plate (TIPSAN stainless steel reconstruction plate system) was passed underneath the spared piriformis and short external rotators extending from lateral ischium to the inferior iliac wing compressing the fractured fragment [15]. After reduction of the fracture, fixation was achieved (Figure 1).


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

Ceylan H, Selek O, Inanir M, Yonga O, Odabas Ozgur B, Sarlak AY - Adv Orthop (2014)

A 26-year-old male patient having acetabular fracture. (a) Preoperative X-Ray. (b) Preoperative 3D-CT scan. (c) Early postoperative X-Ray. (d) Late postoperative X-Ray (24 months).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109071&req=5

fig1: A 26-year-old male patient having acetabular fracture. (a) Preoperative X-Ray. (b) Preoperative 3D-CT scan. (c) Early postoperative X-Ray. (d) Late postoperative X-Ray (24 months).
Mentions: The patients were placed in a prone position on the radiolucent normal operating table under general anesthesia. An incision beginning a handbreadth superior to posterior superior iliac spine on the iliac crest advancing laterally to the greater trochanter and then curving posteriorly towards the gluteal fold was used. Gluteus maximus origin was not detached from the iliac crest; the plane between tensor fascia lata and gluteus maximus was used to reflect the gluteus maximus posteriorly. Distal part of the gluteus maximus insertion to femur was not divided. Then gluteus maximus was reflected posteriorly to provide exposure of the entire posterior pelvis and direct visualization of the sciatic nerve. Working in the superficial plane to external hip rotators, fracture site and when necessary the joint capsule were exposed between either gluteus medius and piriformis or piriformis and superior gemellus interval (superior portal). There was short external rotator muscle damage in the patients with hip dislocation in variable degrees. But at least the quadratus femoris and gemellus inferior muscles were intact in all patients with hip dislocation. The interval between the sciatic nerve and posterior cutaneous nerve of the thigh gives direct access to ischium. Releasing the semimembranosus origin and medial retraction of biceps femoris origin, the posterolateral wall of ischium was reached. Bending template was used for plate contouring. In most fractures gentle retraction of the gluteus medius to widen the superior portal is sufficient to reduce the displaced posterior fragment gently compressing it with a periosteal elevator. A curved 3.5 mm or 4.5 mm reconstruction plate (TIPSAN stainless steel reconstruction plate system) was passed underneath the spared piriformis and short external rotators extending from lateral ischium to the inferior iliac wing compressing the fractured fragment [15]. After reduction of the fracture, fixation was achieved (Figure 1).

Bottom Line: The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta.The greatest loss of strength was in internal rotation.Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Akademi Hospital, 41300 Kocaeli, Turkey.

ABSTRACT
This study analyses the results of the treatment with external rotator sparing approach in acetabular fractures to determine whether muscle sparing has a positive impact on functional outcome. 20 patients with a mean age of 45.9 years (range: 26-64) that had been treated for displaced acetabular fractures were included in this series. Short Musculoskeletal Function Assessment (SMFA) questionnaire and hip muscle strength measurement were done at the 24-month of follow-up period. The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta. The average SMFA score for all of the patients was 18.3 (range: 0-55.4). The mean dysfunctional and bother indexes were 17.2 and 20.6, respectively. The overall muscle strength deficit was 11.8%. The greatest loss of strength was in internal rotation. In patients with better postoperative reduction quality of acetabular fracture, peak torque, and maximum work of hip flexion, extension and also internal rotation maximum work deficit were significantly lower (P < 0.05). Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures.

No MeSH data available.


Related in: MedlinePlus