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Re: Acetabular Fx Surgical Approach
Bruce Ziran 16 Июль 2006, 01:02
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It seems that there are a lot of strong opinions on this matter. Just to stir it up a bit more, I will propose that using a Jackson table, lateral position, with traction, and using the peroneal post with the vertical height adjustment gets the best of both worlds. The vertical post overcomes gravity quite easily and facilitates surgical luxation of the head when longitudinal traction is added. The set up is easy, all of the vectors of forces that those who propose prone positioning can be accounted for, and if a troch osteotomy is needed (for whatever reason), it allows access to more anterior structures. I am definitely not a fan of floppy lateral with manual traction. I agree with Chip, this is absolute torture, but I have used all of the described methods and settled on what seemed easiest. Over come the vectors of deformity, eliminate human fatigue (manual traction), and its not so bad. If a T or bad transverse is tough, it is probably not going to be solved, or caused by the position, but probably justifies a sequential procedure with a second postioning and anterior approach. Acetabular and pelvic surgery seemed to bring out the dogma in us all..
Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine
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Re: Acetabular Fx Surgical Approach
Chip Routt 16 Июль 2006, 09:38
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> It seems that there are a lot of strong opinions on this matter. Just to stir
> it up a bit more, I will propose that using a Jackson table, lateral position,
> with traction, and using the peroneal post with the vertical height adjustment
Simple as this, 99.99% of surgeons can't safely work and clamp through the notch with the patient positioned laterally...it's just not anatomically possible... and it's all about the reduction... we know that.
Imaging is so easy with a prone patient on a radiolucent table, and it's so troublesome with a laterally positioned patient on a fracture table...we know this too.
Fracture tables with perineal posts and sustained traction (to maintain an approximate and "soft tissue tensioned" based reduction) cause complications that we're all very familiar with... if you are too young, ask those who remember the history and evolution of femoral nailing...it's written.
This is not dogma, it's just reality...it is what it is...you know what you know, but you don't know what you don't know.
These details only matter to the patients and those that you try to teach.
That's enough from me-
Chip
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Re: Acetabular Fx Surgical Approach
Отправитель: Flavio Restrepo 16 Июль 2006, 15:16
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I'm with Dr. Chip
The classical papers are:
JBJS 1964; 46A: 1615-46 Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction.Clin Ortthop 1980; 151: 81-106.
Letournel E: Acetabular fractures: Classification and manegament. Springer Verlag 1993. Letournel E, Judet R: Fractures of acetabulum. ed 2, Berlin, Germany
Flavio
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