Ahmed Khalifa, Ali Fergany, Bahaaeldin Ibrahim, Osama Farouk
{"title":"髋臼骨折后从前方入路取出硬件：一项具有挑战性但适用的手术。","authors":"Ahmed Khalifa, Ali Fergany, Bahaaeldin Ibrahim, Osama Farouk","doi":"10.1007/s00264-024-06383-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures.</p><p><strong>Materials: </strong>Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)).</p><p><strong>Results: </strong>The patients' mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36 min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results.</p><p><strong>Conclusion: </strong>Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"249-257"},"PeriodicalIF":2.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703930/pdf/","citationCount":"0","resultStr":"{\"title\":\"Removing hardware from anterior approaches following acetabular fractures: a challenging yet indicated procedure.\",\"authors\":\"Ahmed Khalifa, Ali Fergany, Bahaaeldin Ibrahim, Osama Farouk\",\"doi\":\"10.1007/s00264-024-06383-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures.</p><p><strong>Materials: </strong>Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)).</p><p><strong>Results: </strong>The patients' mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36 min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results.</p><p><strong>Conclusion: </strong>Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.</p>\",\"PeriodicalId\":14450,\"journal\":{\"name\":\"International Orthopaedics\",\"volume\":\" \",\"pages\":\"249-257\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703930/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Orthopaedics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00264-024-06383-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00264-024-06383-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/27 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Removing hardware from anterior approaches following acetabular fractures: a challenging yet indicated procedure.
Purpose: To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures.
Materials: Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)).
Results: The patients' mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36 min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results.
Conclusion: Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
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The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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