Clinical Scorecard: Fixation of a High-Energy Both-Column Acetabular Fracture Using a Lateral Rectus Abdominis Approach Following Total Hip Arthroplasty with Retention of a Stable Acetabular Component: A Case Study

At a Glance

Key Highlights

• Intraoperative assessment confirmed stability of the acetabular cup.
• Open reduction and internal fixation (ORIF) performed via lateral rectus abdominis approach.
• Successful retention of the acetabular component while addressing fracture stability.
• Careful planning of screw trajectories to avoid cup disruption.
• Management of both-column fractures requires simultaneous evaluation of fracture morphology and bone stock.

Guideline-Based Recommendations

Diagnosis

• Use imaging studies such as CT for detailed assessment of fracture patterns and potential component instability.

Management

• Perform open reduction and internal fixation with careful intraoperative assessment of acetabular component stability.

Monitoring & Follow-up

• Structured imaging follow-up to assess for nonunion or secondary component loosening.

Risks

• Potential complications include nonunion, component loosening, and the need for delayed revision surgery.

Patient & Prescribing Data

72-year-old woman with a history of total hip arthroplasty and recent high-energy trauma.

Retention of a stable acetabular component is feasible with appropriate surgical techniques.

Clinical Best Practices

• Ensure thorough preoperative imaging to evaluate fracture and component stability.
• Utilize intraoperative fluoroscopy to confirm stability during reduction and fixation.
• Plan surgical approach to facilitate direct visualization and minimize risk to existing implants.

References

• Clinical considerations for acetabular fractures
• Management of periprosthetic fractures