The Treatment Strategies And Prognosis Of Acetabulum Fracture Combined With Ipsilateral Femoral Intertrochanteric Fracture

Objectives: Acetabulum fracture combined with ipsilateral femoralintertrochanteric fractures is a relatively rare lesion. Often seen in high-energyinjuries or serious osteoporosis, easily to combined dislocation of the hip, andcould not be reduction closely. Ischemic necrosis of femoral head, traumaticarthritis, ossification were common complications, result in poor prognosis inpatients. The injury is rare reports currently, and the best treatment method andprognosis remains to be further defined. This study retrospectively analyzedthe patients admitted to our hospital, try to find the best treatment method andprognosis, in order to improve the understanding of the fracture and definedthe reasonable treatment strategy.Methods: Retrospective analysis a total of18cases of patients withacetabulum fracture combined ipsilateral femoral intertrochanteric fractures inour hospital from January2003to December2012. There were15cases ofmale and3of female, the age were16~87, with the average age of42.8.8cases were left side and10cases were on the right side. The causes were:9cases of traffic injuries and tumble in4cases, falling injury in1case, hit by abruised in4patients. All patients went surgical treatment. The patients werefollow-up with Harris hip score and complications, including incision or deepinfection, necrosis of femoral head, delayed fractures healed. If the patientwent on secondary half or total hip replacement because of joints functionsdegradation, then record the time after the injury and the reasons of the hip ortotal hip replacement, at the same time record the hip joint function in patientspreoperative, as a follow-up to an end.Results:1case of elderly patients (age of87) died of postoperativepulmonary infection, other patient survive the perioperative period.14of themget13~102months follow-up, the average follow-up time of43.82months. The Harris score was55~96, with an average of83.14, including excellent in6cases, good in3patients, fair in2cases, poor in3patients, the excellent togood rate was64.29%. For the followed-up patients,7cases with dislocationof the hip were excellent to good in3, fair to poor in4with3of themdeveloped necrosis of femoral head.7patients without dislocation of the hipwere excellent to good in6, fair to poor in1, with whom had a combinedproximal femoral fractures fixed by intramedullary nail and the screw wentinto the joint cavity. Hip function was poor in5patients, the acetabulumfracture type was4cases of posterior wall,1case after posterior wall andposterior column, the Evans type of intertrochanteric fractures was4cases ofEvans3,1case of Evans4. The fixation of acetabulum fracture was1casewith reconstruction plate,1case with lag screws and3cases withoutacetabulum fixation. The femoral intertrochanteric fracture fixation was2cases with intramedullary nail,3cases with proximal femoral locking plate.3patients with ipsilateral femoral proximal fractures, of which1patients withintramedullary nails went into joint cavity.3cases of patients with femoralhead necrosis.Conclusion: By retrospectively analysis the patients admitted to ourhospital from January2003to December2012, the preliminary understandingof patients prognosis was made. The prognosis of these patients were poor,especially when combined with hip joint dislocation. Femoral head necrosiswere relative common postoperatively. With this part, there is no satisfactorytreatment currently.