INTRODUCTION

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.

Objective: To compare anatomical and functional results after treatment of unstable C-type pelvic fractures with percutaneous iliosacral screws (PISS) and anterior sac-roiliac plating (ASIP) in order to verify the proper indications for both techniques.

Material And Methods: The series consists of 37 patients sustained C-type pelvic lesions with dislocation or fracture-dislocation of SI joint of witch 23 were treated by PISS and 14 by APIS. There were 24 males and 12 females of an average age 33 years (16–64 years). The average ISS in both groups was 26.5 and 23 respectively. The surgery was performed 1 – 18 days after trauma (mean 7 days). Screw fixation was carried out with 2 cannulated screws in the S1 body after close reduction in prone or supine position. ASIP was realised with 2 recon plates or DSP through iliac approach. Simultaneous anterior internal fixation was done in 16 PISS patients and 9 ASIP patients.

RESULTS: Average operative duration was 42 min (25–85) in PISS group and 105 min (70–130) in ASIP group (p< 0.001). The average perioperative blood loss was 50 ml (0–150 ml) and 560 ml (400–950) respectively (p< 0.01). The quality of reduction was evaluated according to Leung criteria. The excellent and good results were 17/23 after PISS (74%) and 13/14 after ASIP (93%): p< 0.005. One patient of each group died due to reasons unrelated to pelvic surgery and the remains were followed up for an average 28 months (10–64). Functional results were rated according Pohlemann et al. In PISS group excellent and good results were 17/22 (74%) and in ASIP group 12/13 (82%): p> 0.005. Except one case of fixation failure and nonunion after PISS without anterior stabilisation there was no major complication in every group.

Discussion: The both methods provide effective dorsal fixation and may be used succesfully in C-type injuries. PISS is much faster and bloodless procedure, but is in lower in respect of acceptable anatomical results. ASIP better reduction and is more suitable for fracture-dislocations. Fair functional results and complications in our series were slightly more common after PISS than after ASIP, but the differences were statistically insignificant. The single major comlication occured when anterior fixation was ignored.

Conclusions: Early after trauma when adequate reduction may be done by close manner PISS is prefferable as less traumatic intervention. When acceptable closed reduction can not be obtained, especially in delayed surgery, we consider ASIP as a method of choice for C-type pelvic fractures.