Date: Tue, 12 Aug 2003 22:45:45 +0200
Subject: Malunited acetabular fracture
Dear Group,
A 50 - years- old female patient had pelvic injury 18m ago due to MVA. Was refered to me for further help, she had skeletal traction for 6 weeks. Her weight 88kg , height 150cm, clinically walking with dependant on the frame with marked limping and 4cm shortening. hip flexion 80 degree, abduction 20 degree, painful movement of the hip. Reviewing her serial x-rays, she had central dislocation causing transverse acetabular fracture with vertical shear involving the sacrum. No neurological deficit.
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She had no medical diseases. Could we help this patient to improve her life?
Dr. Freih Odeh Abu Hassan
Jordan
From: ecthompson - trauma-l@lists.aast.org
Date: Tue, 12 Aug 2003 15:55:46 -0500
This patient is going to require extensive reconstruction of her hip. The acetabulum will need to be reconstructed. The skeletal traction was clearly inadequate. I wouldn't be surprised if the femoral head was compromised.
Start here - http://www.hwbf.org/hwb/conf/orthop.html
There is a section on pelvic trauma. There are some very complex cases that were discussed. One case is a malunion at 8 weeks and is similar to your case. I would also contact Bill Burman and see if he can post your case on the ortho trauma web site.
I'm afraid that your patient will need a hip replacement.
Good Luck,
E
Errington C. Thompson, MD
Trauma Surgeon
Trinity Mother Frances
Tyler, Tx
Date: Thu, 31 Jul 2003 09:33:14 +0600
From: Alexander Chelnokov - orthopod@orthogate.com
Hello Dr.Freih,
DFAHJ> the hip. reviwing her serial x-rays, she had central dislocation with vertical shear involving the sacrum. No neurological deficit. She had no medical diseases.
In our settings operative treatment in 2 stage would be offered: after mobilization of posterior aspect by perQ osteotomy under image intensifier, triradiate exposure of the acetabulum performed, the "book" closed by external fixator or pelvic clamps in supraacetabular areas, with fixaton by reconstructive plates and iliosacral screws. After 3-6 months she would be ready for THA, probably with standard technique.
Pre-THA CT would be he useful.
Best regards,
Date: Wed, 30 Jul 2003 00:17:27 -0700 (PDT)
From: Alaa Zidan - orthopod@orthogate.com
Dear Dr. Frieh
such a challenge , such type of pelvic fractures need to be tackled operatively with no hesitation, but it is too late now
for the time bieng you need to reconstruct the acetabullum by bone grafts such a difficult surgery as the anatomy is distorted , following the creation of good floor and bone stock by bone grafts and stabilisation with reconstructive plates , you proceed as a second stage to total hip replacement
all the best for you frieh
ALAA ZIDAN