Issue: 2026, Vol. 31, No. 1

A. G. Galkin, D. A. Shavyrin, V. P. Voloshin, K. V. Shevyrev, D. V. Martynenko, A. A. Glazkov

RATIONAL ARRANGEMENT OF FIXING ELEMENTS DURING OSSEOUS OSTEOSYNTHESIS OF THE POSTERIOR ACETABULUM AS A PREVENTION OF CONFLICT WITH THE ACETABULUM COMPONENT DURING SUBSEQUENT ENDOPROSTHETICS

Keywords

acetabular fracture, fracture of the posterior wall of the acetabulum, fracture of the posterior column of the acetabulum, post-traumatic coxarthrosis, hip replacement surgery

Abstarct

The key to successful outcomes of reconstructive surgery for acetabular fractures is the accurate anatomical repositioning and rigid fixation of the fractured fragments. To achieve this, most surgeons use a plate and screws to fix the fracture, including through the posterior wall fragments. If a total arthroplasty is required later, it may be necessary to remove the metal fixators due to interference with the acetabular component and previously installed fixation elements. Removing these fixators can lead to additional defects and weaken the acetabulum. At the same time, it is reasonable to believe that efficient placement of osseous plate during acetabular osteosynthesis may help avoid this conflict. The aim of this study is to evaluate whether it is necessary to remove osseous plates and screws during hip arthroplasty in cases of post-traumatic changes to the acetabulum, depending on the type of osseous fixation used. Material and Methods. The results of the treatment of 84 patients were analyzed. They were divided into two groups: 42 patients in each group, depending on the type of access and method of acetabular fixation during reconstructive surgery. In group 1, there was a bridge-like fixation of the posterior acetabulum performed without using screws through the back wall. In group 2, there was a bone reconstruction plate to fix the posterior parts of the acetabulum, with screws inserted through both sciatic and iliac bones as well as through a fragment or fragments of the posterior wall. Endoprosthesis was performed after reconstructive intervention in 30 of the 84 patients. Results and Discussion. Endoprosthetics was required for 5 patients in the first group and 25 patients in the second group. In group 1, none of the patients required the removal of osseous plates and fixators. In group 2, only 10 patients had no structures removed, 6 had partial removal of fixators, and 9 had complete removal of all fixing elements. There was no significant effect of age, gender, injury pattern, and nature, or duration of injury on the need for fixator removal during endoprosthetics. Postoperative sciatic nerve neuropathy developed in only 3 (12%) patients in the second group. Conclusion. The rational arrangement of fixation elements during reconstructive procedures on the acetabulum can reduce the need for removal of fixators, thereby reducing the traumatic nature of the surgery and, consequently, the risk of postoperative sciatic nerve neuropathy.

Скачать

• Quid est Veritas_1_ 2026-55-63