Yıl: 2020 Cilt: 26 Sayı: 2 Sayfa Aralığı: 265 - 273 Metin Dili: İngilizce DOI: 10.14744/tjtes.2019.88472 İndeks Tarihi: 05-10-2020

Acetabular fractures treated surgically: Which of the parameters affect prognosis

Öz:
ABSTRACTBACKGROUND: This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis.METHODS: Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19–67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2–8 years) were performed at least for two years were included in this study.RESULTS: Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3% of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-squarep<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher’s p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patientwas not effective on the clinical outcome (p=0.461).CONCLUSION: It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.
Anahtar Kelime:

Cerrahi olarak tedavi edilen asetabulum kırıkları: Prognozu hangi parametreler etkiler?

Öz:
AMAÇ: Çalışmada, cerrahi yöntemlerle tedavi edilen asetabulum kırıklarında uyguladığımız cerrahi yaklaşımları, oluşan komplikasyonları ve elde edilen klinik ve radyolojik sonuçları değerlendirerek prognoz üstünde etkin olan parametreleri saptamak amaçlandı.GEREÇ VE YÖNTEM: Ocak 1994–Ocak 2014 tarihleri arasında deplase asetabulum kırığı tanısıyla cerrahi tedavi uygulanan 144 olgudan, en az iki yıl süreyle klinik ve radyolojik takipleri yapılan (ortalama takip süresi 34 ay, dağılımı 2–8 yıl) ve yaş ortalaması 36.3 yıl (19–67 yıl) olan 75’i erkek, 28’i kadın toplam 103 hasta çalışmaya alındı.BULGULAR: Hastaların klinik olarak %64’ünde mükemmel ve iyi, %36’sında orta ve kötü sonuç, radyolojik olarak ise %57.3’ünde mükemmel ve iyi, %42.7’sinde orta ve kötü sonuç elde edildi. Kırığın kompleks olması (ki-kare p=0.023), travma ile operasyon arası sürenin artması (p=0.039), cerrahi sürenin altı saatten uzun sürmesi (ki-kare p<0.001), eklem içi basamaklaşmanın 3 mm’den fazla olması (Fisher’s p=0.033), mekanik blok oluşturan komplikasyonların gelişmesi (ki-kare p<0.001) klinik sonuçları kötüleştirmekteydi. Hastaların yaşının klinik sonuç üzerine anlamlı etkisi yoktu (p=0.461).TARTIŞMA: Cerrahi olarak tedavi edilen asetabulum kırıklarının prognozuna etki eden üç temel parametrenin; kırık tipi, cerrahi girişim süresi ve redüksiyon kalitesi olduğu, travma ile operasyon arasında geçen sürenin sonuçları dolaylı olarak etkilediği, avasküler nekroz, heterotropik ossifikasyon ve artirtin ise sadece uzun dönem sonuçları üzerinde olumsuz etkiler yarattığı tespit edildi.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Letournel E, Judet R. Surgical approaches to the acetabulum. In: Elson RA, editor. Fractures of the Acetabulum. Berlin, Heidelberg: Springer; 1993. p. 363−97.
  • 2. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective. Clinical Orthopaedics and Related Research 1994;305:10−9.
  • 3. Stannard JP, Alonso JE. Controversies in acetabular fractures. Clin Orthop Relat Res 1998;353:74–80.
  • 4. Alonso JE, Davila R, Bradley E. Extended iliofemoral versus triradiate approaches in management of associated acetabular fractures. Clin Orthop Relat Res 1994;305:81–7.
  • 5. Tile M. Fracture of the acetabulum. In: Rockwood CA, Green DP, editors. Rockwood and Green’s fractures in adults. 4th ed. Philadelphia: Lippincott-Raven; 1996. p. 1617−58.
  • 6. Judet R, Judet J, Letournel E. Fractures of the Acetabulum: Classification and Surgical Approaches for Open Reduction. Preliminary Report. JBJS American Vol 1964;46:1615−46.
  • 7. Qadir RI, Bukhari SI. Outcome of Operative Treatment of Acetabular Fractures: Short Term Follow-Up. J Ayub Med Coll Abbottabad 2015;27:287−91.
  • 8. Ghalambor N, Matta JM, Bernstein L. Heterotopic ossification following operative treatment of acetabular fracture. An analysis of risk factors. Clin Orthop Relat Res 1994;305:96–105.
  • 9. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996;78:1632–45.
  • 10. Johnson EE, Matta JM, Mast JW, Letournel E. Delayed reconstruction of acetabular fractures 21-120 days following injury. Clin Orthop Relat Res 1994;305:20–30.
  • 11. Nixon JR. Late open reduction of traumatic dislocation of the hip. Report of three cases. J Bone Joint Surg Br 1976;58:41–3.
  • 12. Rowe CR, Lowell JD. Prognosis of fractures of the acetabulum. JBJS 1961;43:30−59.
  • 13. Kınık H. Asetabulum Kırıkları. TOTBİD Derg 2002;1:45−59.
  • 14. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res 1993;292:62–76.
  • 15. Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res 1986;205:230–40.
  • 16. Rickman M, Varghese VD. Contemporary acetabular fracture surgery: treading water or swimming upstream?. Bone Joint J 2017;99-B:1125– 31.
  • 17. McDowell S, Mullis B, Knight BS, Dahners LE. Modified Ollier transtrochanteric approach for the treatment of acetabular fractures. Orthopedics 2012;35:e132–6.
  • 18. Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res 1988;230:83–97.
  • 19. Routt ML Jr, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg Am 1990;72:897–904.
  • 20. Matta JM, Letournel E, Browner BD. Surgical management of acetabular fractures. Instr Course Lect 1986;35:382–97.
  • 21. Suzuki T, Smith WR, Hak DJ, Stahel PF, Baron AJ, Gillani SA, et al. Combined injuries of the pelvis and acetabulum: nature of a devastating dyad. J Orthop Trauma 2010;24:303−8.
  • 22. Johnson EE, Kay RM, Dorey FJ. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture. Clin Orthop Relat Res 1994;305:88–95.
  • 23. Bosse MJ, Poka A, Reinert CM, Ellwanger F, Slawson R, McDevitt ER. Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation. J Bone Joint Surg Am 1988;70:1231–7.
  • 24. Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res 1980;151:81–106.
  • 25. Letournel E. Diagnosis and treatment of nonunions and malunions of acetabular fractures. Orthopedic Clin North America 1990;21:769−88.
  • 26. Tipton WW, D’Ambrosia RD, Ryle GP. Non-operative management of central fracture-dislocations of the hip. J Bone Joint Surg Am 1975;57:888–93.
  • 27. Tile M. Fractures of the acetabulum. Rockwood and Green’s fractures in adults. 3rd ed. Philadelphia: Lipincott-Raven; 1991. p. 1442−79.
  • 28. Shon HC, Choi S, Yang JY. Three-dimensional printing-assisted surgical technique with limited operative exposure for both-column acetabular fractures. Ulus Travma Acil Cerrahi Derg 2018;24:369–75.
APA BİLEKDEMİR U, Civan O, cavit a, özdemir h (2020). Acetabular fractures treated surgically: Which of the parameters affect prognosis. , 265 - 273. 10.14744/tjtes.2019.88472
Chicago BİLEKDEMİR Utku,Civan Osman,cavit ali,özdemir hakan Acetabular fractures treated surgically: Which of the parameters affect prognosis. (2020): 265 - 273. 10.14744/tjtes.2019.88472
MLA BİLEKDEMİR Utku,Civan Osman,cavit ali,özdemir hakan Acetabular fractures treated surgically: Which of the parameters affect prognosis. , 2020, ss.265 - 273. 10.14744/tjtes.2019.88472
AMA BİLEKDEMİR U,Civan O,cavit a,özdemir h Acetabular fractures treated surgically: Which of the parameters affect prognosis. . 2020; 265 - 273. 10.14744/tjtes.2019.88472
Vancouver BİLEKDEMİR U,Civan O,cavit a,özdemir h Acetabular fractures treated surgically: Which of the parameters affect prognosis. . 2020; 265 - 273. 10.14744/tjtes.2019.88472
IEEE BİLEKDEMİR U,Civan O,cavit a,özdemir h "Acetabular fractures treated surgically: Which of the parameters affect prognosis." , ss.265 - 273, 2020. 10.14744/tjtes.2019.88472
ISNAD BİLEKDEMİR, Utku vd. "Acetabular fractures treated surgically: Which of the parameters affect prognosis". (2020), 265-273. https://doi.org/10.14744/tjtes.2019.88472
APA BİLEKDEMİR U, Civan O, cavit a, özdemir h (2020). Acetabular fractures treated surgically: Which of the parameters affect prognosis. Ulusal Travma ve Acil Cerrahi Dergisi, 26(2), 265 - 273. 10.14744/tjtes.2019.88472
Chicago BİLEKDEMİR Utku,Civan Osman,cavit ali,özdemir hakan Acetabular fractures treated surgically: Which of the parameters affect prognosis. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.2 (2020): 265 - 273. 10.14744/tjtes.2019.88472
MLA BİLEKDEMİR Utku,Civan Osman,cavit ali,özdemir hakan Acetabular fractures treated surgically: Which of the parameters affect prognosis. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.2, 2020, ss.265 - 273. 10.14744/tjtes.2019.88472
AMA BİLEKDEMİR U,Civan O,cavit a,özdemir h Acetabular fractures treated surgically: Which of the parameters affect prognosis. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(2): 265 - 273. 10.14744/tjtes.2019.88472
Vancouver BİLEKDEMİR U,Civan O,cavit a,özdemir h Acetabular fractures treated surgically: Which of the parameters affect prognosis. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(2): 265 - 273. 10.14744/tjtes.2019.88472
IEEE BİLEKDEMİR U,Civan O,cavit a,özdemir h "Acetabular fractures treated surgically: Which of the parameters affect prognosis." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.265 - 273, 2020. 10.14744/tjtes.2019.88472
ISNAD BİLEKDEMİR, Utku vd. "Acetabular fractures treated surgically: Which of the parameters affect prognosis". Ulusal Travma ve Acil Cerrahi Dergisi 26/2 (2020), 265-273. https://doi.org/10.14744/tjtes.2019.88472