Abstract
Purpose: We report the operative technique and preliminary results for percutaneous osteosynthesis in the supine position with computed tomography guidance for acetabular fractures without joint displacement.
Material and methods: This prospective study conducted in a single unit included a consecutive non-randomised series of 55 patients who underwent surgery for an unstable pelvic injury between June 1996 and December 2000 under computed tomography guidance. In ten cases, the radiographic and computed tomographic analysis demonstrated a coronal fracture of one of the columns without joint displacement accessible for anteroposterior screw fixation. There were eight men and two women, mean age 35 years.
Surgery: the ten patients were operated on in the supine position, in the scanner room under the same aseptic conditions as in the operation room. The reference computed tomography slice was the Corse slice. The femoral vasculo-nervous bundle was identified. A threaded guide wire was inserted perpendicuallary to the fracture line, anteriorly to posteriorly (Cap Corse technique). A perforated screw with a 7.3 mm diameter was used to fix the fracture. Minimal post-surgical surveillance was 48 hours. Weight bearing was not authorised for six weeks to three months. Al patients were followed prospectively, and mean follow-up ws 16 months (12–36).
Results: Traction was lifted immediately after surgery in all cases. All the patients got up the day after surgery. Mean hospital stay was less than five days postoperatively in all cases. There were no complications (vascular, neurologic, infectious) and no secondary displacement. At last follow-up, he Postel Merle d’Aubigné score was 18 for eight patients, 16 for one and 14 for one. Two patients showed radiographic signs of degenerative hip disease.
Discussion: This percutaneous osteosynthesis method using computed tomographic guidance is reliable (100% well positioned screws) and avoids the need for traction in bed. Morbidity is low (no complications). Even though these eight patients did not present clinical and radiographic signs of osteoarthritis, this technique did not avoid the risk of degenerative hip disease in two patients.
Conclusion: An alternative to traction, percutaneous osteo-synthesis with computed tomographic guidance performed in the supine position for acetabular fractures is a cost-effective procedure.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
