A COMPARATIVE STUDY OF FUNCTIONAL OUTCOME OF SINGLE VERSUS DUAL APPROACH IN PERIACETABULAR FRACTURES. (A PROSPECTIVE NON RANDOMIZED OPEN LABEL STUDY OF 30 CASES)

DR.NIHARKUMAR MAYANI

Volume : VIII, Issue : II, February - 2019

A COMPARATIVE STUDY OF FUNCTIONAL OUTCOME OF SINGLE VERSUS DUAL APPROACH IN PERIACETABULAR FRACTURES. (A PROSPECTIVE NON RANDOMIZED OPEN LABEL STUDY OF 30 CASES)

Dr. Niharkumar Mayani

Abstract :

OBJECTIVES: This study aims at the overall functional outcome and to decide whether single or dual approach should be used in cases of Acetabular fractures. Our primary objective was to determine the choice of surgical approach in the management of periacetabular fractures by comp� the operative time, blood loss, intraoperative and postoperative complications and secondary objective was to study the fracture patterns of acetabular fractures and methods to operate them. MATERIALS AND METHODOLOGY: This prospective study was carried out at the Department of orthopedics, Sir T hospital, Bhavnagar. In this study, around 30 patients (21 males, 09 females; mean age 40 years range 18 to 65 years) with Acetabular fractures (Letournel classification type I and J) were included. 15 Patients having I type of fractures treated with Ilioinguinal approach while rest 15 patients having J type of fractures treated with Kocher Langenbeck approach. The patients were evaluated using HARRIS HIP SCORE score and MERLE D�AUBIGNE score after the treatment. OBSERVATION: Good to excellent results are present in almost all fracture type and in both the scores i.e. HARRIS HIP SCORE score and MERLE D�AUBIGNE score .10 patients got excellent score in MERLE D�AUBIGNE score while 13 patients got excellent score in HARRIS HIP SCORE . There is no any significant difference in results between these two scores. 90% patients returned to their activity at 4 -5 months. CONCLUSION: If acetabulum fractures are operated by experienced surgeon, it gives better outcome. In anterior plus posterior column communited fractures(J type) augmented dual approach (Ilioinguinal+Kocher Langenbeck) platting is preferred over single approach. In anterior column fractures with posterior hemitransverse fractures(I type) only anerior Illioinguinal approach acetabular plating gives good stability and functional outcome. If the surgery is well planned,intra operative reduction is anatomical and the associated morbidity is less patient can achieve near normal range of movement. SUMMARY: In order to obtain stability of complex acetabular fractures,reduction and fixation of both the columns is necessary if posterior column communition is more(J type). Hence augmented dual approach(IL+KL) platting is preferred over single.While in anterior column fractures with posterior hemi transverse(I type) only anerior illioinguinal approach acetabular plating gives good stability and functional outcome.In this research we evaluated the results of acetabular platting in single(IL) versus dual(IL+KL) approaches.