A Single Shot Arthroscopic Reduction and Screw Fixation of Posterior Wall Acetabular Fracture
2Orthopedic Surgery Department, Rivka Ziv Medical Center, Israel
Background:
Traumatic posterior dislocation of the hip joint is commonly associated with displaced fracture of the acetabular posterior wall. Insufficient anatomic reduction may lead to secondary osteoarthritis of the joint. Therefore, a traditionally open surgical approach is performed in order to debride the joint, reduce and fix the posterior wall and restore the hip joint anatomy. In this series, we present a novel minimally-invasive approach using hip arthroscopy to irrigate the joint, reduce and fix the fracture of the acetabular posterior wall.
Methods:
Three patients with an average age of 25.3 years (range 21-29), with displaced acetabular posterior wall fracture caused by traumatic hip joint dislocation, were treated in our facility. Computed tomography (CT) of the hip joint showed displaced fracture and a decision for surgical reduction was taken. Using a supine hip arthroscopy approach, the joint was lavaged and cleaned from debris of the intra-articular fracture. Using the posterior portal, under direct vision the fracture, anatomic reduction and internal fixation were obtained. Postoperative CT was performed to determine reduction quality. Patients were restricted to a partial weight-bearing protocol with progression to full weight-bearing within 3 months following surgery. Pelvic plain radiographs were performed postoperatively during outpatient visits. Patient-reported outcome scores were obtained (iHOT 12 and modified Harris Hip Score – (MHHS)).
Results:
Average follow-up was 21 months (range 13-31 months). All three cases had an anatomic reduction and good fixation of the fracture, as demonstrated in CT scans. Of the three patients, one had no symptoms or pain in the hip joint, one had developed heterotropic ossification, and one reported signs of clinical impingement in osteoarthritis. Nevertheless, all three patients resumed normal gait within 3 months. The mean IHOT12 score was 68 (range 43-93.5) and the mean MHHS was 79 (range 73-91). Two of the patients returned to their pre-injury level of function, and one patient reported reduced functional activity.
Conclusions:
Displaced fracture of the posterior wall of the acetabulum following hip joint dislocation can be treated with a minimally invasive approach of hip arthroscopy-assisted closed reduction and internal fixation. This surgical technique is safe for the patient, with a satisfactory clinical and radiological result. However, it is not flawless, as our series demonstrated heterotopic ossification and osteoarthritis in two of the cases.