- Discussion:
- use similar stratedgy as one would use for
posterior wall frx
w/ distraction of the femoral head, removal of all intra-articular fragments
& correction of femoral head depressions;
- Approach:
- use
Kocher Langenbeck approach w/ prone positioning of patient, unless
frx is remote, in which case, use extended
iliofemoral approach;
- femoral head is distracted and incarcerated fragments are removed;
- Reduction & Fixation:
-
Reduction of
transverse fracture is carried out first;
- fixation of transverse frx with lag screws into superior ramus;
- long cancellous screw is transfixed into superior pubic ramus;
- it may not possible to obtain initial fixatoin w/ lag screw;
- in this case, begin fixation w/ plate along
greater sciatic notch;
-
posterior wall frx is adressed;
- first remove of osteocartilaginous fragments;
- correction of femoral head depressions;
-
posterior wall frx is reduced & fixed with lag screws;
- curved plate is then applied from the ischial tuberosity to inferior
ilium, which bridges the transverse and
posterior wall frx;
