The Efficacy And Complication Study On Acetabular Fractures Treated With Reconstruction Plate Via K-L Approach

ObjectiveTo evaluate the treatment results and its complication reason of acetabular fractures fixed with reconstruction plate through the K-L approach respectively by retrospective analysis in order to reduce the incidence of the complications and improve the clinical efficacy.MethodsBased on inclusion criteria and exclusion criteria,the clinical information of the patients with acetabular fractures treated with reconstruction plate through the K-L approach was collected form January1999to June2010at Wuhan General Hospital of Guangzhou Command.Three standard Judet X-ray radiography such as anteroposterior hip,obturator oblique,iliac oblique, and pelvic CT and3D reconstruction should be taken in all the cases before operation. K-L approach indicated a curved incision from the posterior superior iliac spine or below two transverse finger along the iliac crest to extend outwards, and then longitudinal down at transtrochanteric to expose the fracture. Reconstruction plate and3.5mm screws were used to fix the reduced fractures. A follow-up plan was formulated, which include outpatients chief complaint, clinical physical examination and three standard Judet X-ray radiography. Matta standards was used to evaluate the fracture reposition and Clinical function was evaluated by the Merled’Aubighe and Postel functional system.Results35cases with complete clinical data were selected from54acetabular fracture patients who had been treated by internal fixation via kocher-langenbeck approach according to inclusion criteria and exclusion criteria. All patients had been followed up for1.2years to12years(an average of4.2years). Based on the Matta standards, the fracture reduction results were as fellows:excellent in22cases, good in10cases, fair in3cases. In the last follow-up, postoperative functional recovery was evaluated by the Merled’ Aubighe and Postel functional, which include three aspects:the patient’s level of pain, walking function and joint activities. The results were as follows: excellent in15cases, good in11cases, fair in4cases and poor in5cases, good rate of74.3%. A few postoperative complications were found:one case of wound infection, one case of sciatic nerve injury, one case of urinary tract stones, four cases of avascular necrosis, three cases of traumatic arthritis and one case of heterotopic ossification. This study shows that femoral head (neck) fractures have an impact on postoperative ischemic necrosis and hip dislocation reseted in a timely manner can avoid the sustained damage and reduce the occurrence of postoperative complications.ConclusionsPart of the acetabular fractures can be treated with internal fixation via K-L approach and achieve relatively good results. The surgery efficacy is affected by combining femoral fractures before treatment, damage of femoral head cartilage, bone fragments in the articular cavity, the quality of fracture restoration and functional exercise after the treatment. Timely processing of associated injuries, early surgery, reducing the side injury, high-quality reset and early safe and effective functional exercise can reduce the occurrence of postoperative complications and improve the clinical efficacy.