Aim and Purpose of the study

The authors evaluate the efficacy of athrodiatasis as possible alternative to arthrodesis or arthroplasty in the treatment of ankle arthritis in young patients. They present the long term results (average 19 years) of a small series of patients (10 cases) treated with a monolateral transarticular external fixator associated to different open or athroscopic procedures.

Anatomical reduction of the joint is the primary aim in the treatment of acetabular fractures as any other articular fracture. The current standard of care provides open reduction and internal fixation (ORIF) through differentiated surgical approaches which have been associated with relatively high complications rate such as haematomas, superficial and deep infection, and neuro-vascular lesions. Moreover these procedures need long operative times with significant blood loss. To avoid these general and local complications, that sometimes compromise the functional outcome of the operation and the possibility to perform a future arthroplasty, some authors advocated a minimally invasive percutaneous osteosynthesis (MIPO). This approach can also be considered a valid alternative to ORIF in all those cases in which the standard approaches are contraindicated as in open fractures, comminuted fractures in osteoporotic patients or fractures in high risk patients.

Between 2001 and 2006 we performed MIPO techniques for acetabular fractures in 15 patients; the reduction has been evaluated with fluoroscopy during the operation and with CT after the operative procedure. In almost all the cases the reduction has been achieved and maintained using an ileo-femoral external fixator according to the ligamentotaxis technique. The frame is applied in distraction bridging the joint from the contra-lateral iliac wing to the omolateral femoral shaft associating whenever possible percutaneous cannulated 4 mm. screws to optimise the reduction and obtain fragment fixation. The fixator is left in place from a minimum of 20 days to a maximum of 40 days in relation to the comminution of the fracture and/or the quality of the bone.

Following this strategy is possible to achieve good reduction and fracture stability avoiding the poor results of conservative treatment or the risk of major complications related to ORIF. According to the radiological and clinical results obtained the best reduction can be achieved when the treatment is carried out early and the best stability when we associate to the fixator 1 or 2 cannulated screws. The use of external fixation has never compromised the range of movement of the knee (secondary to quadriceps transfixion) and we have never had deep infection related to pin tract problems in the 3 to 6 weeks treatment period.

Anatomical reduction of the joint is the primary aim in the treatment of acetabular fractures as any other articular fracture. The current standard approach provides open reduction and internal fixation (O.R.I.F.) through a variety of surgical approaches which have been associated with relatively high complications rate such as haematomas, deep infection, and neuro-vascular lesions. These procedures need long operative times with significant blood loss.

Many authors have demonstrated the feasibility of closed reduction and percutaneous fixation (C.R.P.F.) for minimally or non displaced acetabular fractures; this technique can be considered a valid alternative to O.RI. F. in order to decrease the morbidity related to surgical approaches.

Between 2001 and 2006 we performed C.R.P.F. for acetabular fractures in 15 patients; the reduction has been controlled with fluoroscopy during the operation and with CT scan after the operative procedure. The osteosinthesis has been performed with cannulated screws and In more complex cases the reduction has been achieved and maintained with ileo-femoral external fixation (ligamentotaxis technique).

Fractures were classified according to AO classification. Clinical and functional results have been evaluated according to Harris Hip Score on the base of post-operative CT scan and on x-ray films at last follow-up.

According to our experience the use of external fixation in the treatment of acetabular fractures must be reserved for very selected cases in which for general or local condition the joint the distraction associated with minimal internal fixation can guarantee good reduction and fracture stability avoiding the poor results of conservative treatment or the risk of major complications related to ORIF. The best reduction can be achieved when the treatment is carried out early while the best stability is achieved with the association of percutaneous cannulated screws. The use of external fixation has never compromised the range of movement of the hip.