FEATURES OF THE ACETABULUM POSTERIOR WALL FRACTURES DELAYED SURGICAL TREATMENT.

OBJECTIVE: The aim: To analyse the results of the delayed acetabulum posterior wall fractures treatment and to identify the negative factors affecting the outcome. PATIENTS AND METHODS: Materials and methods: The patients' treatment results have been assessed in 5 years after the surgery. The surgery was performed in 21 to 120 days after the injury, 44±11 days on average. 23 individuals (19 men and 4 women) were included in the retrospective analysis. RESULTS: Results: Anatomical fracture reposition was achieved in 12 (52.2%) cases, imperfect but satisfactory reposition - in 7 (30.4%) cases. 4 (17.4%) cases resulted in unsatisfactory reposition. Hip arthroplasty was performed in 5 patients over the following 5 years. CONCLUSION: Conclusions: The delayed fractures of the acetabulum posterior wall (21 to 120 days after the injury) is the complicated task for a surgeon. The aseptic necrosis and deforming arthrosis were found in 1-5 years after treatment. The preparation for the anatomical reposition takes a big amount of time and effort from the orthopedic team because of technical peculiarities.

FEATURES OF THE FEMORAL HEAD FRACTURES COMBINED WITH ACETABULUM POSTERIOR WALL FRACTURES SURGICAL TREATMENT.

OBJECTIVE: The aim: To conduct a thorough analysis of the surgical approach features in femoral head fractures combined with acetabulum posterior wall fractures; to analyze these patients' treatment results 12-36 months after the surgery; to determine the criteria affecting the satisfactory treatment results achievement in these injuries. PATIENTS AND METHODS: Materials and methods: The surgical treatment results were evaluated 13 and 36 months after the surgery. The retrospective analysis included 21 patients (17 men and 4 women) with femoral head fractures combined with the acetabulum posterior wall fractures. Pipkin and Brumback classifications were used to classify the fractures. RESULTS: Results: The results of acetabulum posterior wall fractures delayed treatment are significantly different to the ones treated with early osteosynthesis. The reasons for that are difficulties in anatomical repositioning, femoral head malnutrition due to its displacement or chronic subluxation, reduced blood supply to the fragments due to surgical manipulations during the approach. Thus, according to Matta criteria anatomical reposition of the fragments was achieved in 19 (90.5%) cases, imperfect reposition in 1 (4.8%) case, unsatisfactory reposition - in 1 (4.8%) patient. The treatment results' improvement after 3 years occurred due to hip joint replacement in 5 (23.8%) patients. CONCLUSION: Conclusions: The treatment results of femoral head fractures with acetabulum posterior wall fractures depends on the type of fracture, concomitant injuries, the timing, and method of removing the femoral head dislocation, and the surgical treatment method.