Bruce_Ziran at HMIS
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Jul 24, 2006, 2:26 PM
Post #3 of 4
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Re: [ORT-L] fracture floor of acetabulum
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I agree with Chip, a posterior approach alone will result in a world of
pain. There may be a free fragment that may get incarcerated. Also, the
anterior fracture line, whether indicative of a low column component or
associated wall will need to be addressed. I have found that using what we
term the sub-inguinal window of the Ilioinguinal approach really helps
visualize the quad surface and post column. It is done by going on the
other side of the table, and working under the vessel and muscle envelopes.
You can push the bladder out of the way and get all the way back to the SI
joint.
The only aspect that I diverge from Chip a little is with locked plates. We
get a lot of osteoporotic bone and I like the stability they offer. Not
ROUTINE but nice to have the option. ALso, with the locked holes, you can
cheat a little by not screwing the guide all the way and directing it just
slightly. I find that within about 10-15 degrees, the screws still "bite".
Granted, an interference fit, but with Stainless, this is not the same
problem as with the soft LISS plates. As Chip states, not used for majority
of cases, but only when needed.
(See attached file: View.ppt)
I enlosed a ppt on some of the views of the other window. It has already
been published and presented at OTA several times by us and others.
Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine
"Rajesh"
<rajesh84@asianet
india.com> To
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Subject
[ORT-L] fracture floor of
07/24/2006 12:00 acetabulum
PM
Please respond to
ORT-L@www2.aaos.o
rg
55 yr old lady (cleaning lady at our hospital) hit by a car (merc C
class,no
less !) 4 days ago. I think she has a comminuted floor of right acetabulum
with a transverse # and involvement of both anterior and posterior columns.
Only other injury is a # of neck of scapula on the left side. I am planning
to operate on wednesday.After following all the discussions,I was thinking
of a prone kocher-langenbck exposure ( have only done a few lateral ones
before,but I can see the advantages), and use recon plates posteriorly. I
will then have to do an anterior approach as well and fix the superior
ramus
using plates as I have been unable to get any ramus screws. Is there any
advantage in using locking recon plates as opposed to ordinary recon plates
(so that i dont have to use very long screws?)
Thanks for any suggestions and any other options. Some more CT films are
available and i will send them across as soon as possible.
rajesh
Dr.K.R.Rajesh, MS,DipNB,FRCS,FRCS(Orth)
Consultant Upper Limb Surgeon
Division of Upper Limb , Arthroscopy & Joint Replacement Surgery.
Cosmopolitan Hospital
Trivandrum,Kerala,India.
Mobile-9447191205
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www.choicemailfree.com(See attached file: acetab1.jpg)(See attached file:
acetab2.jpg)(See attached file: acetab-ct1.jpg)(See attached file:
acetab-ct2.jpg)(See attached file: acetab-ct3.jpg)
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