Abstract
Introduction and Aims: The use of the triradiate approach has been associated with high rates of wound dehiscence, wound infection and significant heterotopic ossification. This approach has been the favoured extensile exposure at the Vancouver General Hospital for many years. We will review the outcomes of the use of this approach in the treatment of acetabular fractures.
Method: Patients were identified from the database at Vancouver General Hospital who had their acetabular fractures treated through a triradiate approach from the period January 1989 through to December 2001. Patients with a delay of greater than three weeks from injury were excluded. A retrospective review of the hospital and out-patient records and all available radiographs was performed. Patients were contacted to determine if they required any further surgery and to assess their current functional status with appropriate outcome scores. Patients were also invited to undergo repeat radiographic assessment.
Results: Of a total of 407 acetabular fractures treated surgically, 152 open reductions were performed through the triradiate approach. The average age of these patients was 38 years and 114 (75%) of these were male. Patients referred from other hospitals totalled 128 (84%). Wound outcomes were known in 138 cases. Wound complications included five cases of wound dehiscence, of which four resolved with no undue effects. There were three cases of superficial wound infection and five cases of deep wound infection. Two of the patients with deep wound infection had sustained compound acetabular injuries and a further two had significant risk factors for infection (septicaemia from chest infection and significant soft tissue necrosis). Trochanteric osteotomy was performed in 139 (91%) cases. There were only two cases of trochanteric non-union in this series, however 21 cases required removal of painful trochanteric screws. With respect to heterotopic ossification, there was a 15% Broker III/IV incidence. In this group, the injury severity scores were higher, there was a greater delay to surgery and there was a greater need for mechanical ventilation due to multiple injuries. In the group, 24 hip reconstructions were required over the period.
Conclusion: In our centre, we found a low rate of wound dehiscence and deep wound infection associated with the triradiate approach in the treatment of acetabular fractures. Both open acetabular fractures developed deep infection. Trochanteric irritation was a problem in a number of the patients. The rate of significant hetero-topic ossification was low.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
