[ORT-L] acetabular fracture - Orthopedics Forum


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[ORT-L] acetabular fracture

andonov at doctor
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Nov 30, 2008, 3:38 AM

Post #1 of 6 (1897 views)
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[ORT-L] acetabular fracture	Can't Post

Dear All ,

I would like to present a case of a young (22 yo) male who suffered a car crush. He has combined transverse and posterior wall fracture of the right acetabulum as well as a nondisplaced fracture of the left acetabulum and bimalleolar fracture of the left ankle. Initially we did a combined lateral and axial traction to the right leg . The patient is stable now ( 6 day after the accident ), so I would like to ask for your opinion for the best course of treatment of the right acetabulum.

Best regards,

Yordan Andonov MD

Ruse, Bulgaria

Attachments:

ap.jpg (55.7 KB)

ct1.jpg (64.2 KB)

ct2.jpg (52.9 KB)

ct3.jpg (71.9 KB)

ct4.jpg (65.2 KB)

post traction day 2.jpg (83.3 KB)

alex61 at gmail
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Nov 30, 2008, 11:30 AM

Post #2 of 6 (1894 views)
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Re: [ORT-L] acetabular fracture [In reply to]	Can't Post

Dear Yordan

> bimalleolar fracture of the left ankle. Initially we did a combined
> lateral and axial traction to the right leg . The patient is stable now ( 6

See http://www.wheelessonline.com/ortho/transverse_frx_of_acetabulum
Lateral traction is rather harmful than useful because pin tract
infection close to further surgical wound increases risk.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
---
[This E-mail scanned for viruses by Declude Virus]

mlroutt at u
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Nov 30, 2008, 8:49 PM

Post #3 of 6 (1888 views)
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Re: [ORT-L] acetabular fracture [In reply to]	Can't Post

The details of the fracture are not so clear from the images sent...would you be able to send along an AP and Judet images as well as some additional axial images above and below the joint?

I'm not so sure that your patient has a Tr+PW pattern based on the images sent...maybe the fracture's exact name won't matter in the long run, but it'd be great to see enough images to make an accurate comment.

Thanks-

Chip

M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--

Dear Yordan

> bimalleolar fracture of the left ankle. Initially we did a combined
> lateral and axial traction to the right leg . The patient is stable now ( 6

See http://www.wheelessonline.com/ortho/transverse_frx_of_acetabulum
Lateral traction is rather harmful than useful because pin tract
infection close to further surgical wound increases risk.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
---
[This E-mail scanned for viruses by Declude Virus]

trtoaljr at comcast
New User

Nov 30, 2008, 9:13 PM

Post #4 of 6 (1887 views)
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Re: [ORT-L] acetabular fracture [In reply to]	Can't Post

Without complete CT images and/or oblique radiographs, it's difficult to answer your question definitively, but it appears that there may not be a posterior wall fracture that requires a posterior approach. A successful reduction through an ilio-inguinal approach will have a faster recovery, and not risk SGN injury or heterotopic ossification.

Tom Toal
Portland, Oregon

----- Original Message -----
From: "Andnonov MD" <andonov@doctor.bg>
To: ORT-L@www2.aaos.org
Sent: Sunday, November 30, 2008 3:38:45 AM GMT -08:00 US/Canada Pacific
Subject: [ORT-L] acetabular fracture

Dear All ,

I would like to present a case of a young (22 yo) male who suffered a car crush. He has combined transverse and posterior wall fracture of the right acetabulum as well as a nondisplaced fracture of the left acetabulum and bimalleolar fracture of the left ankle. Initially we did a combined lateral and axial traction to the right leg . The patient is stable now ( 6 day after the accident ), so I would like to ask for your opinion for the best course of treatment of the right acetabulum.

Best regards,

Yordan Andonov MD

Ruse, Bulgaria

andonov at doctor
New User

Dec 1, 2008, 5:38 AM

Post #5 of 6 (1887 views)
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Re: [ORT-L] acetabular fracture [In reply to]	Can't Post

Here are some more axial images. What is your opinion as for the
timing of the operative treatment?

Best regards,

Yordan Andonov

Quoting "Milton L. Routt" <mlroutt@u.washington.edu>:

> The details of the fracture are not so clear from the images
> sent...would you be able to send along an AP and Judet images as
> well as some additional axial images above and below the joint?
>
> I'm not so sure that your patient has a Tr+PW pattern based on the
> images sent...maybe the fracture's exact name won't matter in the
> long run, but it'd be great to see enough images to make an accurate
> comment.
>
> Thanks-
>
> Chip
>
>
> M.L. Chip Routt, Jr.,M.D.
> Professor-Orthopedic Surgery
> Harborview Medical Center
> 325 Ninth Avenue
> Box 359798
> Seattle, WA 98104-2499
> phone 206-731-3658
> FAX 206-731-3227
> --
>
>
>
>
>
>
>
>
> Dear Yordan
>
>> bimalleolar fracture of the left ankle. Initially we did a combined
>> lateral and axial traction to the right leg . The patient is stable now ( 6
>
> See http://www.wheelessonline.com/ortho/transverse_frx_of_acetabulum
> Lateral traction is rather harmful than useful because pin tract
> infection close to further surgical wound increases risk.
>
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>
>

Attachments:

8603035286_0_0_23.jpg (60.1 KB)

8603035286_0_0_27.jpg (71.9 KB)

8603035286_0_0_28.jpg (65.5 KB)

8603035286_0_0_29.jpg (67.8 KB)

8603035286_0_0_30.jpg (65.4 KB)

8603035286_0_0_33.jpg (73.1 KB)

8603035286_0_0_36.jpg (85.3 KB)

8603035286_0_0_37.jpg (84.9 KB)

mlroutt at u
New User

Dec 2, 2008, 9:02 PM

Post #6 of 6 (1871 views)
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Re: [ORT-L] acetabular fracture [In reply to]	Can't Post

I'd operate on it 2-5 days after injury.

Thanks for the additional images...unfortunately, I'm still unsure what exposure(s) that I'd use...but, my best guess is that I'd start with an ilioinguinal.

chip

Here are some more axial images. What is your opinion as for the
timing of the operative treatment?

Best regards,

Yordan Andonov

Quoting "Milton L. Routt" <mlroutt@u.washington.edu>:

> The details of the fracture are not so clear from the images
> sent...would you be able to send along an AP and Judet images as
> well as some additional axial images above and below the joint?
>
> I'm not so sure that your patient has a Tr+PW pattern based on the
> images sent...maybe the fracture's exact name won't matter in the
> long run, but it'd be great to see enough images to make an accurate
> comment.
>
> Thanks-
>
> Chip
>
>
> M.L. Chip Routt, Jr.,M.D.
> Professor-Orthopedic Surgery
> Harborview Medical Center
> 325 Ninth Avenue
> Box 359798
> Seattle, WA 98104-2499
> phone 206-731-3658
> FAX 206-731-3227
> --
>
>
>
>
>
>
>
>
> Dear Yordan
>
>> bimalleolar fracture of the left ankle. Initially we did a combined
>> lateral and axial traction to the right leg . The patient is stable now ( 6
>
> See http://www.wheelessonline.com/ortho/transverse_frx_of_acetabulum
> Lateral traction is rather harmful than useful because pin tract
> infection close to further surgical wound increases risk.
>
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>
>

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