[ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation


	MAIN INDEX	SEARCH POSTS	WHO'S ONLINE	LOG IN

Forum: OWL Lists: OTA:
[ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation

jjbrooksmd at gmail
New User

Dec 8, 2008, 11:06 AM

Post #1 of 6 (2130 views)
Shortcut

[ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation	Can't Post

List Members,

I would appreciate your opinion re: immediate THA vs. ORIF in the attached case.

62 y.o. diabetic male 2 days s/p L PW/PC 'tab fx-dislocation. Another
orthopod 'closed reduced' and placed traction.

Dislocated now for 2 days. Significant chondral injury to fem head as
well as a lot of impaction of the PW component.

In a 62 y.o., is he best served with one procedure -- immediate THA,
or is ORIF with careful Tx of marginal impaction/articular congruency
preferred?

Not much god evidence in literature to guide this decision, so I
respectfully request you opine.

Jeff Brooks

Stamford, CT

Attachments:

AC PC PW tab.ppt (428 KB)

Adam.Starr at UTSouthwestern
New User

Dec 8, 2008, 11:22 AM

Post #2 of 6 (2130 views)
Shortcut

Re: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation [In reply to]	Can't Post

Hi Jeff,

The CT scans are small, but it looks like he may have a transverse
line running across the dome. The post column fx line may be all the
way across, just not as displaced in front as in back.

Posterior walls are tough to manage percutaneously!

I think I would open it, reduce and graft the marginal impaction and
stabilize the posterior wall, plus stabilize the transverse fx line
(if there's actually one there).

But you're right, there's not a heckuva lot of objective data to
guide us.

Good luck,

Adam
On Dec 8, 2008, at 1:06 PM, Jeff Brooks wrote:

> <AC PC PW tab.ppt>

---
[This E-mail scanned for viruses by Declude Virus]

Adam.Starr at UTSouthwestern
New User

Dec 8, 2008, 11:22 AM

Post #3 of 6 (2130 views)
Shortcut

Re: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation [In reply to]	Can't Post

mlroutt at u
New User

Dec 8, 2008, 12:01 PM

Post #4 of 6 (2130 views)
Shortcut

Re: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation [In reply to]	Can't Post

That's unfortunately not an uncommon clinical scenario...it's great that you've seen him at only 2 days after injury.

That patient has a very routine injury pattern.

It sure does look like a Transtectal Transverse with an Associated Posterior Wall pattern...the transverse component is not so obvious anteriorly on your 3D imaging...but it is on the 2D axial images.

I'd beg you for routine open reduction and internal fixation if I was that patient.

chip

List Members,

I would appreciate your opinion re: immediate THA vs. ORIF in the attached case.

62 y.o. diabetic male 2 days s/p L PW/PC 'tab fx-dislocation. Another
orthopod 'closed reduced' and placed traction.

Dislocated now for 2 days. Significant chondral injury to fem head as
well as a lot of impaction of the PW component.

In a 62 y.o., is he best served with one procedure -- immediate THA,
or is ORIF with careful Tx of marginal impaction/articular congruency
preferred?

Not much god evidence in literature to guide this decision, so I
respectfully request you opine.

Jeff Brooks

Stamford, CT

dgoetz at ghs
New User

Dec 15, 2008, 6:32 AM

Post #5 of 6 (2112 views)
Shortcut

RE: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation [In reply to]	Can't Post

As someone who believes in total hips for unfixable acetabular fractures
[unfixable for many reasons] and with a strong desire to do the total as
a primary procedure not salvage, I would fix this fracture.

-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of Jeff Brooks
Sent: Monday, December 08, 2008 2:06 PM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation

List Members,

I would appreciate your opinion re: immediate THA vs. ORIF in the
attached case.

62 y.o. diabetic male 2 days s/p L PW/PC 'tab fx-dislocation. Another
orthopod 'closed reduced' and placed traction.

Dislocated now for 2 days. Significant chondral injury to fem head as
well as a lot of impaction of the PW component.

In a 62 y.o., is he best served with one procedure -- immediate THA,
or is ORIF with careful Tx of marginal impaction/articular congruency
preferred?

Not much god evidence in literature to guide this decision, so I
respectfully request you opine.

Jeff Brooks

Stamford, CT
---
[This E-mail scanned for viruses by Declude Virus]

wdburman at frontiernet
New User

Dec 16, 2008, 8:22 AM

Post #6 of 6 (2106 views)
Shortcut

Re: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation [In reply to]	Can't Post

------ Forwarded Message
From: Chip Routt <<>mlroutt@u.washington.edu>
Date: Mon, 15 Dec 2008 06:46:41 -0800
To: <<>ORT-L@www2.aaos.org>
Conversation: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation
Subject: Re: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation

It'd be great if you'd share with the list your experience regarding-

1. what are the factors and details that make an acetabular
fracture "unfixable"?
2. once deemed "unfixable", how do you achieve a stable
acetabular component within the "unfixable" acetabular fracture?
3. is the arthroplasty timed differently than a fixation would?
4. do you use a period of traction initially, if so for how long and why?
5. how do you deal with such details as columnar instability,
articular area comminution and crush, wall instability or
comminution, local soft tissue defects, among significant others?

Could you please show us some examples?

Thank you-

mlcr

At 9:32 AM -0500 12/15/08, David Goetz wrote:
>As someone who believes in total hips for unfixable acetabular fractures
>[unfixable for many reasons] and with a strong desire to do the total as
a primary procedure not salvage, I would fix this fracture.

-----Original Message-----
From: <>ORT-L-owner@www2.aaos.org
[<mailto:ORT-L-owner@www2.aaos.org>mailto:ORT-L-owner@www2.aaos.org]
On
Behalf Of Jeff Brooks
Sent: Monday, December 08, 2008 2:06 PM
To: <>ORT-L@www2.aaos.org
Subject: [ORT-L] total hip versus ORIF - PC/PW acetab fx-dislocation

List Members,

I would appreciate your opinion re: immediate THA vs. ORIF in the
attached case.

62 y.o. diabetic male 2 days s/p L PW/PC 'tab fx-dislocation. Another
orthopod 'closed reduced' and placed traction.

Dislocated now for 2 days. Significant chondral injury to fem head as
well as a lot of impaction of the PW component.

In a 62 y.o., is he best served with one procedure -- immediate THA,
or is ORIF with careful Tx of marginal impaction/articular congruency
preferred?

Not much god evidence in literature to guide this decision, so I
respectfully request you opine.

Jeff Brooks

Stamford, CT
---
[This E-mail scanned for viruses by Declude Virus]

------ End of Forwarded Message
---
[This E-mail scanned for viruses by Declude Virus]

Search for (options)