Surgical dislocation of the hip for reduction of acetabular fracture and evaluation of chondral damage.
OBJECTIVE
To assess the outcome of open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fractures.


METHODS
20 men and 2 women aged 20 to 55 (mean, 28) years underwent open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fracture. The most common fracture pattern was bicolumnar (n=12), followed by transverse (n=6) and T-type (n=4). Femoral head chondral lesions were classified as grade 0 (no defect) to grade 4 (osteochondral defect). Fracture fragments were fixed with titanium plates and screws, and the femoral head was redislocated to inspect for intraarticular screws. The association between functional status and acetabular fracture pattern and femoral head chondral lesions was explored.


RESULTS
Nine patients had chondral lesions in the femoral head (mostly in the anterosuperior zone), but none in the acetabulum. All femoral heads were viable. Reduction was anatomic in 6 patients and satisfactory in 16. Functional outcome was very good in 6 patients, good in 13, medium in 2, and fair in one. No patient developed avascular necrosis of the femoral head. Four patients had iatrogenic sciatic nerve palsy. One patient developed early degenerative hip arthritis and underwent total hip arthroplasty 14 months later.


CONCLUSIONS
Surgical dislocation of the hip facilitated anatomic reduction and inspection of any chondral lesions. It did not result in avascular necrosis of the femoral head.
Department of Orthopaedic Surgery, The Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India.
Lalit
L
Maini
Sahil
S
Batra
Sumit
S
Arora
Shailendra
S
Singh
Santosh
S
Kumar
V K
VK
Gautam
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D000328:Adult; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
acetabulum; femur head necrosis fracture
fixation; fracture fixation