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Management of Neglected Acetabular Fractures -Primary Complex Total Hip Replacement with Impaction grafting using Sandwich technique.


Presenting Author - Ashish Singh
Introduction Management of neglected acetabular fractures is a difficult task. Osteosynthesis in such cases may not be an ideal solution. THR in neglected acetabular fracture is considerable worse than after conventional hip replacement. Methods Sandwich technique is not yet described in the literature and the results obtained so far are encouraging.We use a mixture of bone milling and bone chips of various sizes and the available femoral head is cut in slices. The cancellous bone slice is incorporated like a sandwich in the defect in addition to under laying and overlaying bone chips. The reconstruction aids in more mechanical stability and relies on the ability to gain biological fixation of the component to the underlying host bone. Prospective Study was done on with impaction Grafting using Sandwich technique. Post operative analysis of the radiographs was done on FDA approved PACS software.Acetabular component position, abduction Angle, Migration and change in angulations was noted. Graft thickness was measured in Dee Lee Charnley Zones. The results are encouraging and there is a statistical significant improvement in the functional scores. Radiological results are excellent. The average Abduction angle was 43.5 degrees. The average Migration not classified as failures were 1.8mm (range 0-4 mm). Delayed absorption was seen in one case with a cemented cup. The average time of graft incorporation mean was 5.4 months. Conclusion 13 neglected acetabular defect cases (Paprosky type III) were operated with this technique and Favorable mid-term results has been reported with a high rate of graft incorporation when this technique is used for neglected acetabular defects. The advantages of bone grafting by this includes more mechanical stability in addition to the ability to restore bone stock, rebuild a normal hip center and hip biomechanics, and increase bone stock for future revisions.