Acta Chir Orthop Traumatol Cech. 2012; 79(5):411-415 | DOI: 10.55095/achot2012/058

Conservative Treatment of Acetabular Both Column Fractures: Does the Concept of Secondary Congruence Work?Original papers

GÄNSSLEN, A.1,*, HILDEBRAND, F.2, KRETTEK, C.2
1 Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum der Stadt Wolfsburg, Wolfsburg, Germany
2 Unfallchirurgische Klinik,, Medizinische Hochschule Hannover, Hannover, Germany

Complete separation of all bony fragments around the acetabulum in both column fractures can lead to extra-anatomical orientation of these fragments around the femoral head with the potential of a "secondary congruence". No long-term data are known in the literature.
We could follow 35 patients were a both column fracture was treated non-operatively due to different reasons. Demographics, fracture type, additional fracture lesions (comminution, marginal impaction), the clinical and radiological result and joint failure (severe arthrosis, FHN, esc. THR) were analyzed.
The mean age was 38 years, 27 patients were male, eight female. All but four were multiply injured with a mean ISS of 22 points. 16 patients had additional pelvic ring injuries.
The majority of patients showed a C1-fracture of the acetabulum (anterior column multifragmentary, posterior column simple).
31 patients healed in secondary congruence (88%). Primary displacement was half (11,4 mm, 3-27 mm) compared to patients without secondary congruence (20 mm, 17-22 mm). 80% of the patients had none or only slight pain and 77% had an excellent or good functional result (Merle d'Aubigné Score). The rate of joint failure due to non-union, femoral head necrosis, posttraumatic degenerative changes or pain was relatively low with 17% after a mean of 5 years following trauma.
In selected patients, conservative treatment of both column fractures can lead to acceptable long-term results with a high rate of secondary congruence.

Published: October 1, 2012  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
GÄNSSLEN A, HILDEBRAND F, KRETTEK C. Conservative Treatment of Acetabular Both Column Fractures: Does the Concept of Secondary Congruence Work? Acta Chir Orthop Traumatol Cech. 2012;79(5):411-415. doi: 10.55095/achot2012/058. PubMed PMID: 23140596.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. BAKER, S., O'NEILL, B.: The Injury Severity Score: an update. J. Trauma, 16: 882-885, 1976. Go to original source... Go to PubMed...
    2. BOSCH, U., POHLEMANN, T., HAAS, N., TSCHERNE, H.: Klassifikation und Management des komplexen Beckentraumas. Unfallchirurg, 95: 189-196, 1992.
    3. BROOKER, A., BOWERMAN, J.W., ROBINSON, R.A., RILEY L.H. JR.: Ectopic ossification following total hip replacement: incidence and a method of classification. J. Bone Jt Surg., 55-A: 1629-1632, 1973. Go to original source...
    4. DEBRUNNER, H.: Orthopädisches Diagnostikum. 5. Aufl., Thieme, Stuttgart, New York: 34, 1987.
    5. FICAT, R., ARLET, J.: Ischemia and necrosis of bone. Williams & Wilkins, Baltimore, London 1980.
    6. GÄNSSLEN, A., FRINK, M., HILDEBRAND, F., KRETTEK, C.: Both column fractures of the acetabulum: epidemiology, operative management and long-term-results. Acta Chir. orthop. Traum. čech., 79: 107-113, 2012. Go to original source...
    7. GIANNOUDIS, P.V., GROTZ, M.R., PAPAKOSTIDIS, C., DINOPOULOS, H.: Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J. Bone Jt Surg., 87-B: 2-9, 2005. Go to original source...
    8. LETOURNEL, E.: Fractures of the pelvis and acetabulum. Springer-Verlag, 1993.
    9. LEVINE, R., RENARD, R., BEHRENS, F., TORNETTA, P.: Biomechanical consequences of secondary congruence after both-column acetabular fracture. J. Orthop. Trauma, 16: 87-91, 2002. Go to original source... Go to PubMed...
    10. MATTA, J.: Operative indications and choice of surgical approach for fractures of the acetabulum. Techn. Orthop., 1: 13-22, 1986. Go to original source...
    11. MATTA, J.: Fractures of the acetabulum: accuracy of reduction and clinical results of fractures operated within three weeks after the injury. J. Bone Jt Surg., 78-A: 1632-1645, 1996. Go to original source...
    12. MATTA, J., MEHNE, D., ROFFI, R.: Fractures of the acetabulum: early results of a prospective study. Clin. Orthop., 186: 241-250, 1986. Go to original source...
    13. MERLE D'AUBIGNÉ, M.: Traitement chirurgical de la coxarthrie. Soc. Intern. Chir. Orthop., 21: 240-247, 1948.
    14. MOORE, E., COGBILL, T., MALANGONI, M., JURKOVICH, G., SHACKFORD, S., CHAMPION, H., McANNICH, J.: Organ Injury Scaling. Surg. Clin. North Am., 75: 293-303, 1995. Go to original source... Go to PubMed...
    15. OCHS, G., MARINTSCHEV, I., HOYER, H., ROLAUFFS, B., CULEMANN, U., POHLEMANN, T., STUBY, F.: Changes in the treatment of acetabular fractures over 15 years: Analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury, 41: 839-851, 2010. Go to original source... Go to PubMed...
    16. OLSON, S., BAY, B., HAMEL, A.: Biomechanics of the hip joint and the effects of fracture of the acetabulum. Clin. Orthop., 339: 92-104, 1997. Go to original source... Go to PubMed...
    17. OTA, Fracture and dislocation compendium. J. Orthop. Trauma, 10(Suppl. 1): 71-75, 1996.
    18. POHLEMANN, T., GÄNSSLEN, A., HARTUNG, S. für die Arbeitsgruppe Becken: Beckenverletzungen/Pelvic Injuries. Hefte zu "Der Unfallchirurg", Heft 266, 1998.
    19. TEASDALE, G., JENETT, B.: Assessment of coma and impaired consciousness: a practical scale. Lancet, 2: 81-83, 1974. Go to original source... Go to PubMed...
    20. TSCHERNE, H., REGEL, G., STURM, J., FRIEDL, H.: Schweregrad und Prioritäten bei Mehrfachverletzungen. Chirurg, 58: 631-640, 1987.

    Return to the content