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Original ArticleOpen Access
Reconstruction of the Pelvic Brim and its Role in the Reduction Accuracy of Displaced T -shaped Acetabular Fracture
Harnraangraj T 
,
Asavamangkalkul A ,
Chareanchavanich K
,
Asavamangkalkul A ,
Chareanchavanich K Open reduction of the displaced T-shaped acetabular fracture has a problem of accuracy
of the fracture reduction. This study was carried out to demonstrate that the reconstruction of the
pelvic brim by approaching the pubo-acetabular fragment plays a role in the accuracy of the
reduction of displaced T-shaped acetabular fractures. From 1975 to 1990, a retrospective study was
carried out of 22 patients who sustained a displaced T-shaped acetabular fracture. The patients
were operated on by open reduction and internal fixation of the ischio-acetabular fragment to the
posterior column without restoration of thepelvic -brim. Radiographs of the pelvis were reviewed.
The result showed that there was displacement of the pubo-acetabular fragment including the
medial wall in all cases. As the result of this study, a prospective study between 1990 and 1997 was
carried out of 15 patients who sustained displaced T -shaped acetabular fractures including 3
cases with medial displacement of the femoral head. The pubo-acetabular fragment was anato-
mically reduced and fixed to the anterior column of the acetabulumn as the first approach to
restore a disrupted pelvic brim. There, patterns of the acetabular fracture were subsequently
re-evaluated especially the ischio-acetabular fragment including the position of the femoral head
by using an intraoperative portable X-ray technique. The stability of the hip joint was assessed
by hip flexion. The intraoperative
r~diograph
appearances of the ischio-acetabular fragment were
visually confirmed by a second surgical exposure. The results showed that the intraoperative
radiographs gave spontaneous reduction of the ischio-acetabular fragment in all patients except
one. There was a reduction of the displaced femoral head into the hip socket in the three patients.
The hip joints were stable in all patients. The second surgical exposure showed that there was
good spontaneous reduction of the ischio-acetabular fragment to the posterior column by liga-
mentotaxis in 14 patients. Therefore, it is not necessary to address the ischio-acetabular fragment.
In the exceptional case, the ischio-acetabular fragment was displaced as a free bone which could
not be reduced by ligamentotaxis. However, reduction and internal fixation of the ischio-
acetabular fragment to the posterior column for complete
re-appli~ation
of the hip joint onto the
*
Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok I 0700,
Thailand.
484
of the fracture reduction. This study was carried out to demonstrate that the reconstruction of the
pelvic brim by approaching the pubo-acetabular fragment plays a role in the accuracy of the
reduction of displaced T-shaped acetabular fractures. From 1975 to 1990, a retrospective study was
carried out of 22 patients who sustained a displaced T-shaped acetabular fracture. The patients
were operated on by open reduction and internal fixation of the ischio-acetabular fragment to the
posterior column without restoration of thepelvic -brim. Radiographs of the pelvis were reviewed.
The result showed that there was displacement of the pubo-acetabular fragment including the
medial wall in all cases. As the result of this study, a prospective study between 1990 and 1997 was
carried out of 15 patients who sustained displaced T -shaped acetabular fractures including 3
cases with medial displacement of the femoral head. The pubo-acetabular fragment was anato-
mically reduced and fixed to the anterior column of the acetabulumn as the first approach to
restore a disrupted pelvic brim. There, patterns of the acetabular fracture were subsequently
re-evaluated especially the ischio-acetabular fragment including the position of the femoral head
by using an intraoperative portable X-ray technique. The stability of the hip joint was assessed
by hip flexion. The intraoperative
r~diograph
appearances of the ischio-acetabular fragment were
visually confirmed by a second surgical exposure. The results showed that the intraoperative
radiographs gave spontaneous reduction of the ischio-acetabular fragment in all patients except
one. There was a reduction of the displaced femoral head into the hip socket in the three patients.
The hip joints were stable in all patients. The second surgical exposure showed that there was
good spontaneous reduction of the ischio-acetabular fragment to the posterior column by liga-
mentotaxis in 14 patients. Therefore, it is not necessary to address the ischio-acetabular fragment.
In the exceptional case, the ischio-acetabular fragment was displaced as a free bone which could
not be reduced by ligamentotaxis. However, reduction and internal fixation of the ischio-
acetabular fragment to the posterior column for complete
re-appli~ation
of the hip joint onto the
*
Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok I 0700,
Thailand.
484
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