تبديل مفصل الورك البدئي بعد كسور الجوف الحقي

Background& Objective: The acetabular bone deficiency secondary to acetabular fractures presents a complex clinical problem and a big challenge to the orthopedic surgeons due to the technical difficulties related to this deficiency, considering that significant number of patients treated either surgically or without surgery will require T.H.A in the future. The purpose of our study was to determine the outcome of T.H.R performed in patients with a history of acetabular fracture. Materials & Methods: We performed T.H.R in 21 patients with previous acetabular fractures in Al-Assad Hospital between2004-2009prespectively, these cases were divided into 3 groups: -first group formed of 7 patients were treated conservatively. Second group formed of 9 patients did an open reduction and internal fixation by screws and plates. -Third group formed of 5 elderly patients with fresh acetabular fractures and were treated primarily by a total prosthesis with use a reinforcement Muller ring . For the clinical evaluation of our cases we used the modified Harris Hip Score Scale and for the radiological evaluation we used the Delee and Charnley scale system . Results: Our overage Harris Hip Score was 83.(80 for the first group, 86 for the second group, and 83 for the third group). -No complications were encountered intraoperative, in the early postoperative period one case developed superficial wound infection and treated by repeated dressing and antibiotic, there was one case of D.V.T on the 4th day treated by rest and anticoagulant, and one case developed loosening of acetabular component 8 months after T.H.A and underwent to revision. Conclusion: T.H.R in acetabular fractures despite the difficulties faced during the procedure is a safe and effective way to salvage the hip when secondary osteoarthritis develops, open reduction and internal fixation of acetabular fractures may have benefits even if it fails to prevent posttraumatic arthritis .Furthermore the clinical results of T.H.R after surgical treatment of acetabular fractures are better than it after conservative treatment of these fractures. Reinforcement ring is an ideal solution when the decision of T.H.R is taken as a primary treatment of acetabular fractures depending on the indications described by Joly