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Re: Acetabular Fx Surgical Approach
послал Rahul Banerjee 16 Июль 2006, 00:29
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I'm glad to see there is finally a good discussion about Acetabular fractures on the list.
Just to toss another point into the mix:
The lateral position allows for the trochanteric osteotomy ("slide") and surgical dislocation as described in Siebenrock et. al. Surgical Dislocation of the Femoral Head for Joint Debridement and Accurate Reduction of Fractures of the Acetabulum, JOT 2002. This is a useful adjunct for 1)intra-articular fragment removal, 2)assessment of transverse fracture line reduction, 3) treatment of associated femoral head fractures. I am not sure that this is possible with a prone K-L approach.
Peter Trafton taught me how to do an excellent KL in the lateral position which is what I use for posterior wall, posterior column, and associated fractures. Perhaps I have not done enough cases yet to encounter great difficulty, but I think you can gain excellent access to the column, the sciatic notch and control and reduce column and wall fractures. It is necessary to constantly be vigilant about extending the hip and flexing the knee to prevent sciatic nerve problems.
But I'm always willing to learn and maybe I can come up to Seattle some time and have Chip show me the beauty of the prone approach.
Rahul Banerjee
El Paso, TX
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