Posterior Acetabular Rim Fracture with Hip Dislocation

Master the treatment of posterior acetabular rim fractures associated with hip dislocation. This training offers a technical immersion in a carefully planned and executed surgical approach, aiming for the reduction of fragments, fixation to restore joint congruence, and hip stability.

Training Focus:

• Surgical treatment of posterior acetabular rim fractures with hip dislocation.
• Kocher-Langenbeck surgical access.
• Reduction and fixation of fragments to restore the anatomy and function of the joint.
• Protection of neurovascular structures, with emphasis on the sciatic nerve and the circumflex artery.
• Reconstruction of the external rotator muscles.

Detailed Content:

• Initial Assessment and Optimized Surgical Access: Learn to interpret computed tomography scans to identify hip dislocation and large fragments of the posterior acetabular rim. Master the Kocher-Langenbeck approach, using landmarks such as the apex of the greater trochanter, the posterior superior iliac spine, and the long axis of the femur.
• Dissection and Strategic Exposure: Develop the skill to perform an incision in the iliotibial tract and blunt dissection through the fibers of the gluteus maximus. Identify and elevate the gluteus medius, and perform a tenotomy of the gluteus maximus to facilitate exposure. Identify the external rotators, including the piriformis, superior gemellus, internal obturator, and inferior gemellus.
• Neurovascular Protection and Safe Tenotomy: Perform the tenotomy of the piriformis and identify the superior and inferior gemelli muscles, as well as the internal obturator. Understand the crucial protection of the quadratus femoris, due to the passage of the circumflex artery that nourishes the head of the femur in this region. Use the retracted tendons (piriformis and gemelli) as cushioning for the sciatic nerve, which runs adjacent to the access.
• Identification and Accurate Reduction of Fragments: Learn how to identify the inferior and superior fragments of the acetabular roof. Understand how to clean and detach the joint for better identification of reduction parameters, and reposition the fragments in their anatomical locations after dislocation reduction.
• Temporary Fixation and Plate Molding: Master the technique of introducing the inferior retractor into the lesser sciatic notch after careful detachment. Temporarily fix the fragments with Kirschner wires. Use aluminum to mold a model of the plate, which will be used to create a definitive mold for the fixation plate.
• Definitive Fixation with Multiple Plates: Learn how to fix the main plate to the ischium, surrounding the entire posterior rim, with screws directed towards the acetabular roof. Use a second plate at the vertex of the upper fragment for fixation. Understand how the use of these two plates provides satisfactory reduction and stability, eliminating the need for spring plates.
• Anatomical Reconstruction and Closure: Perform the identification and reconstruction of the piriformis, superior gemellus, inferior gemellus, and internal obturator tendons. Learn how to reinsert the piriformis into its original position, with slight external rotation of the hip assisting in the reinsertion of the tendons.Restore the anatomical structure while preserving the femoral square and the gluteus medius, without muscle cuts. Finish with the suture of the iliotibial tract.

Included Material:

• Detailed Technical PDF: Educational document that describes the surgical procedure for the treatment of fractures of the posterior rim of the acetabulum associated with hip dislocation, from the initial assessment to reconstruction and closure.

Enhance your skills in hip surgery. Enroll now and master advanced techniques for acetabular reconstruction, ensuring the restoration of joint congruence and hip stability for your patients.