Delays in the surgical treatment of acetabular fractures often results in extensile or combined approaches being required. This study reports the outcome from a regional centre aiming to treat these fractures via a single surgical approach where possible.

Seventy-two patients (73 displaced acetabular fractures) with an average age of 39.5 years (range 15–76 years) were studied with an average follow up period of 45.5 months (range 24–96). All radiographs were reviewed together with a full clinical assessment of each patient including the Harris Hip Score.

Thirty-four fractures were simple and 39 were complex including 27 both column fractures. Eight were noted to have an associated injury to the femoral head. The average time from injury to surgery was 11.7 days (range 1–35 days) with 80 percent of cases being operated on within two weeks after injury.

In 67 fractures (92%), including 24 both column fractures, a single approach alone was used (Anterior Ilioin-guinal 26 cases; Posterior Kocher-Langenbeck 41 cases). Five fractures needed an extensile triradiate approach and only one case required a combined anterior and posterior approach. A congruent reduction (gap or step of 2mm or less) was achieved in 65 cases (89%). Functional outcome was good with an average Harris Hip Score of 85 (range 20–100). There were 2 cases of deep infection (2.7%) and 4 patients (5.5%) required later hip replacement. There were no cases of venous thrombosis. Twenty cases exhibited heterotopic ossification of varying degree but none of these were grade IV.

Conclusion: In most cases, internal fixation of a displaced acetabular fractures is possible via a single surgical approach. Morbidity and complications are much reduced but single approach surgery requires that patients are assessed and treated early and prompt referral to a specialist unit is recommended.

Aim: We report results of surgical treatment of acetabular fractures and highlight the importance of single approach for complex fractures. Methods: 50 acetabular fractures referred to a specialist unit between 1994 and 1999 were treated surgically with anatomic reduction and internal þxation. Mean follow up was 32.3 months (14 to 67). Patients were regularly followed up in a special pelvic clinic for documentation of Harris hip score (pain, function, movement, activity), and radiological evidence of healing, avascular necrosis or other complications. Results: 18 patients were treated with the anterior ilioinguinal approach for 11 both- column, 3 anterior column, 3 transverse fractures and 1 central dislocation. 28 patients had posterior Kocher-Langenbeck approach for 17 posterior fracture dislocations, 2 both-column, 6 posterior wall and 1 each of transverse, posterior column and Tshaped fracture. 4 needed combined anterior- posterior or extensile triradiate approach due to comminution or delayed referral. Mean hospital stay was 24.7 days and mean injury surgery interval was 10.8 days. Of the 42 transfers from other units, 7 had surgery after 3 weeks from the injury. Outcome: 47 patients were followed up. Mean Harris hip score was 82.7 (31–100) for the posterior approach group, and 78.1 (27–99) for anterior approach group.3 patients needed total hip arthroplasty for secondary arthritis. Grade3–4 Brooker ectopic bone was noted in 3 posterior and 1 anterior approaches. There was no infection or avascular necrosis. Conclusion: Single approach surgery was possible in 46 patients and had a low rate of complications. Poor outcome occurred in highly comminuted fractures or with a delay in referral. Anterior ilioinguinal approach, although demanding, was the approach of choice for both column fractures. Early referral to a specialist unit is recommended.

Aims: To assess shoulder function and pain following open reduction and internal fixation of displaced 2, 3 & 4 part fractures of the proximal humerus, using a new fixation plate designed to provide rotation and angle stability.

Methods: Patients treated by open reduction and internal fixation with a PlantTan plate (PTP) in our institution are currently being followed-up for a period of 2 years from time of surgery. Post-operatively Constant-Murley (0–100) and Visual analogue (0–100) scoring systems are being used to assess function and pain at 2, 6, 12, and 24 months post surgery. Complications have been carefully recorded.

Results: Currently 24 patients have been treated with a PTP. Results to 6 months post surgery are presented here. Mean patient age is 65 (31–89), 11 male, 13 female. Three were undertaken for non-union and 21 for acute fractures. At 2 months post surgery mean Constant-Murley Score (CMS) was 24 (12–49) on the fractured side compared to 89 (80–95) on the uninjured shoulder, with a mean Visual Analogue Score (VAS) of 37 (1–82). At 6 months mean CMS was 49 (28–75) for the fractured side compared to 88 (71–100) for the uninjured side, with a mean VAS of 26 (2–69). Three patients have died during the follow-up period; all deaths have been confirmed, by the coroner, as being unrelated to the procedure. Screws have backed out in 3 (12.5%) patients with 1 requiring implant removal and 1 requiring revision. There has been 1 (4.2%) case of frozen shoulder requiring MUA and 3 (12.5%) superficial wound infections. All 3 infections have resolved following a course of oral antibiotics.

Conclusion: We believe the PTP may prove to be a powerful tool in the management of proximal humeral fractures, however further evaluation including long-term follow-up is required. We aim to report on this in the future.