Management of neglected residually displaced acetabular fractures is a big challenge. ORIF is often doomed to failure so a primary total hip replacement is usually kept in mind as a method of choice. However THR is a technically difficult and results are quiet unpredictable. OBJECTIVE. To present our experience with THR in maltreated grossly displaced acetabular fractures and to discuss operative technique and prognostic factors in that complicated surgery. THR was applied in 14 patients (11 males and 3 females, mean age 51 years) with at least three-months old and significantly displaced acetabular fractures. In 12 cases preceding treatment was conservative, and in 2 it was operative. Fracture nonunion was recognized in 5 cases, old hip dislocation in 4 and protusion in 3. Large interfragmentary gaps and local bone defect were detected in almost all cases.INTRODUCTION
MATERIAL
Elbow: excellent 69(92%) vs./52(74.3%), good 6(8%) vs./16(22.8%), poor 0 vs./2(2.9%). Complications noted were iatrogenic nerve palsy 1(1.3%) vs./12(17%), delayed union 5(7%) vs./2(3%), non union 1(1.3%) vs./5(7%), infection 0 vs./1(1.4%), fixation failure 1(1.3%) vs./5(7%) and reosteosynthesis 1(1.3%) vs./1(1.4%), shoulder impingement 8(11%) vs./2(3%).
Fifteen patients were operated immediately and the rest Ð between the 5th and the 10th day. The average operative time was 335 minutes. The patients were operated by the standard technique of AO. Osteotomy of the olecranon was used in all patients except for 3 patients. All the fractures were stabilised with 2 plates except for 2 patients (1 plate). The osteotomy was þxated with a tension wire and K-wires. Carefully assisted rehabilitation was started at average on the 9th day.