Acetabular fracture non-union with pelvic discontinuity treated with two-stage total hip arthroplasty after intra- and extra-articular plate fixation

• Published in: Nagoya journal of medical science 2019-02, Vol.81 (1), p.113-119
• Main Authors: Morita, Daigo, Seki, Taisuke, Takegami, Yasuhiko, Kasai, Takehiro, Higuchi, Yoshitoshi, Ishiguro, Naoki
• Format: Article
• Language: English
• Subjects: Original Paper
• ISSN: 0027-7622; 2186-3326
• DOI: 10.18999/nagjms.81.1.113

Surgical intervention for the treatment of acetabular fracture non-union is often challenging. Here, we present a case of acetabular fracture non-union with pelvic discontinuity in a patient who underwent cemented total hip arthroplasty (THA) after intra- and extra-articular plate fixation. The case was a 70-year-old male with left T-shaped acetabular fracture non-union neglected for 5 months after the injury. The anterior and posterior columns were not healed, and the articular surface was displaced toward the medial side with a protrusion of the collapsed femoral head. As the first surgical intervention, we performed intra- and extra-articular plate fixation after femoral head decapitation. We fixed non-union regions from the inferior acetabular margin to the anterior column using a pelvic reconstruction plate bent three-dimensionally at the acetabular curvature on the intra-articular side. Furthermore, we fixed that of the posterior column on the outside of the acetabulum using a bent pelvic reconstruction plate. Union of the anterior and posterior columns was observed at 4 and 6 months after the first surgical intervention. At 7 months, we performed a cemented THA without additional bone grafting. At 1-year follow-up, the patient did not have left coxalgia and could walk without any gait supports. Based on our experience, we propose this surgical protocol as a useful treatment option for cases of acetabular fracture non-union.