Christopher J Lenarz1, Berton R Moed. 1. Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri 63110-8850, USA.
Abstract
OBJECTIVES: The purpose of this study was to describe a form of anterior wall acetabular fracture, which has been inadequately defined in the literature. DESIGN: Retrospective analysis of consecutive patients. SETTING: Level 1 trauma center. PATIENTS: A retrospective analysis of consecutive acetabulum patients treated by a single surgeon between 1999 and 2005 identified 6 patients with a form of anterior wall fracture without involvement of the pelvic brim. All fractures were treated operatively. INTERVENTION: Open reduction and internal fixation through an anterior surgical approach. MAIN OUTCOME MEASUREMENTS: Final radiographic appearance and modified Merle d'Aubigne score. RESULTS: All 6 cases demonstrated characteristics of an atypical fracture of the anterior wall, involving the anterior rim of the acetabulum similar in nature to those described for the posterior wall, rather than the standard anterior wall fracture type described by Letournel. Of the 6 cases that were identified, 5 had follow-up 1 year or greater with a mean modified Merle d'Aubigne Score of 17 (range: 17-18). CONCLUSION: A form of anterior wall acetabular fracture exists, which involves the anterior acetabular rim without involvement of the pelvic brim. It can occur in young patients with high-energy mechanisms of injury, as well as in the elderly with low-energy trauma. With appropriate surgical management, using a modified Smith-Peterson approach, good to excellent clinical outcomes should be expected.
OBJECTIVES: The purpose of this study was to describe a form of anterior wall acetabular fracture, which has been inadequately defined in the literature. DESIGN: Retrospective analysis of consecutive patients. SETTING: Level 1 trauma center. PATIENTS: A retrospective analysis of consecutive acetabulum patients treated by a single surgeon between 1999 and 2005 identified 6 patients with a form of anterior wall fracture without involvement of the pelvic brim. All fractures were treated operatively. INTERVENTION: Open reduction and internal fixation through an anterior surgical approach. MAIN OUTCOME MEASUREMENTS: Final radiographic appearance and modified Merle d'Aubigne score. RESULTS: All 6 cases demonstrated characteristics of an atypical fracture of the anterior wall, involving the anterior rim of the acetabulum similar in nature to those described for the posterior wall, rather than the standard anterior wall fracture type described by Letournel. Of the 6 cases that were identified, 5 had follow-up 1 year or greater with a mean modified Merle d'Aubigne Score of 17 (range: 17-18). CONCLUSION: A form of anterior wall acetabular fracture exists, which involves the anterior acetabular rim without involvement of the pelvic brim. It can occur in young patients with high-energy mechanisms of injury, as well as in the elderly with low-energy trauma. With appropriate surgical management, using a modified Smith-Peterson approach, good to excellent clinical outcomes should be expected.
Authors: Martin Henri Hessmann; Patrick Ingelfinger; Sven Oliver Dietz; Pol Maria Rommens Journal: Oper Orthop Traumatol Date: 2009-09 Impact factor: 1.154