Friday 5 March 2010

78 year old gentleman, hypertensive and well controlled diabetic sustained a both coloumn fracture rt. acetabulum following a fall down the steps. Relevant 3D pics are attached.

















Comments please

In view of his age and communition we planned ORIF and primary THR. His haemoglobin was 8 gms we made us think of 1. fixing the posterior column and wall and use a multiholed cup if good,stable posterior superior host bone contact is obtained or 2.cage if we cant get the same.





attached are the pics with good posterior superior contact and primary THR. Host bone autografy used medialy to avoid protrusio.
On your rt is the 3 month xray and is now full wt bearing> no migration detected yet.
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5 comments:

  1. Dr Hitesh Gopalan30 April 2010 at 23:40

    conclusions of study published in "MAY" 2010, Journal of Orthopaedic Trauma by D.Hersovici et al..

    - The combined hip procedure(ORIF +THA) is an option for acetabular fractures in elderly patients.
    - Complications, surgical times,
    and hospitalizations are consistent with open reductions or belated total hip arthroplasties.
    - Aggressive medical workups may be needed,
    but a single posterior surgical procedure will avoid the ‘‘wait-andsee’’
    approach often used for these patients.

    ReplyDelete
  2. Dr Jacob Varghese1 May 2010 at 07:37

    although our surgical plan include an antegrade antr column screw. it was deferred as the patient preop hb was 8 and we felt the construct was stable enough as we got good posterior superior contact more than 70%. PATIENT IS PARTIAL WT BEARING ON WALKER TILL 3 MONTHS. Dana Mears have shown that migration of th cup is possible and should be looked for.

    ReplyDelete
  3. sanjay.B26 May 2010 at 09:28

    Would jacob consider percutaneous fixation of both column and ilium, and mobilise the patient immediately and later do the THA?

    ReplyDelete
  4. Dr Jacob Varghese26 May 2010 at 12:07

    the major posterior wall will be a problem for percutneous fixation.

    Why wait for 3 months in an elderly man? ONE SHOT AT BOTH IF IT WORKS SPECIALLY DUE TO THE WALL COMMUNITION.

    ReplyDelete
  5. Dr Jacob Varghese5 August 2010 at 20:38

    Dr. illavarasu presented the case for the COS with some relavant references. Iwill see if this can be uploaded or shared.

    ReplyDelete