THE TREATMENT OF ACETABULAR FRACTURES THROUGH THE TRIRADIATE APPROACH

Abstract

There are a variety of surgical approaches available for open reduction and internal fixation of acetabular fractures. Some centres have avoided the use of the triradiate approach in the belief that it may result in a significantly higher rate of heterotopic ossification. This has not been our experience. In contrast to many centres, acetabular fractures are treated in an emergent manner, with surgery usually undertaken within the first few days post injury. It is the investigators’ belief that this may in part result in a lower rate of heterotopic ossification.

The triradiate approach has fallen out of favour in the treatment of acetabular fractures due to concerns with both wound healing and heterotopic ossification. This approach however has been utilised frequently at the Vancouver General Hospital (VGH) in the treatment of acetabular fractures. The purpose of this study was to review the results and complications of this approach experienced in the large series at VGH.

We concluded that the results of this approach are acceptable with the exposure allowing anatomical fracture reduction in the vast majority of cases. The complication rate was low, as was the rate of heterotopic ossification.

The significance of this study is to highlight that this approach remains extremely useful in the treatment of acetabular fractures, due to its ability to give excellent exposure while still having an acceptably low complication rate. We believe that the ability of our unit to operate on these injuries in an emergent manner may impart the low rate of heterotopic ossification that we have observed.

There were a total of one hundred and sixty-one acetabular fractures that were treated operatively with the triradiate approach over the period 1989 to 2001. Of these, the majority were two column injuries (79 or 49%), T type fractures (34 or 21%) and transverse fractures (17 or 11%). The average age of the patients was thirty-seven years and the average time to surgery was three days. Our early complications included five cases of failure of fixation or loss of reduction of the fracture, two cases of neurovascular injury, two cases of superficial wound infection, one case of deep wound infection and one case of wound breakdown.

The study involved examining patient hospital records and radiographs and included fracture types, patient ages, delay to surgery, post-operative complications and degree of fracture reduction and healing. Grading of heterotopic ossification was performed by reviewing the anteroposterior radiographs and using Gruen’s classification system.