The Journal of Bone and Joint Surgery, Vol 72, Issue 6 897-904, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure
ML Routt and MF Swiontkowski
Department of Orthopaedics, University of Washington, Seattle 98104.
Over a four-year period, twenty-four patients who had a complex fracture of
the acetabulum were treated by the same surgeon. The operation consisted of
open reduction and internal fixation with combined anterior and posterior
exposures during the same period of anesthesia. The cases of these patients
were reviewed to ascertain whether access to both acetabular columns during
the same procedure facilitates open reduction and internal fixation and to
determine the indications for this combined procedure. As determined by
intraoperative assessment and at follow-up examination four to thirty-two
months postoperatively, anatomical reduction and rigid fixation were
achieved in 88 per cent of the patients. No patient had an infection of the
wound. All twenty-four patients had some degree of heterotopic
ossification; as defined by Brooker et al., it was Class I in seven, Class
II in thirteen, Class III in three, and Class IV in one. However, the
heterotopic ossification limited motion of the hip enough to impair
function in only two patients. We concluded that combined anterior and
posterior exposures facilitate reduction and fixation and that these
approaches should be used during the same period of anesthesia whenever
anatomical reduction and rigid internal fixation cannot be achieved through
a single exposure. Heterotopic ossification should be expected
postoperatively, but it is rarely clinically important, at least in the
short term.
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