Surgical Discussion

If it weren’t for this pesky medial dome fragment, this would be simple- KL approach, disimpact the joint, reduce, squeeze and plate the posterior column. But that medial joint piece is big and important. So it’s a game changer- here is how I thought about it and why we did what we did. Question to myself #1) can I reliably do this all from the back? Honest answer to myself- maybe but I’m not sure I have a good enough window thru the pc (very small pw fragments) so the main articular fragment (unclear if it’s free from its cortex or still intact to it. ) If I can’t get it right, can I fix the column/impaction/wall first and then go supine to get the fragment thru and AIP? Maybe, but if the column isn’t right, there’s no way I’ll get that large fragment right. Question #2) Can I do this all from the front? No. PC way off and low enough that getting it right from the front would be really hard- also, can’t directly reduce the impaction. Interestingly I asked a few of my acetabulum expert colleagues and they all had differing opinions! I decided to keep it as simple as possible- AIP to reduce the main joint fragment, then flip prone, KL, deal with the impaction and column. Unfortunately- that big joint fragment was free from its cortex, so what I was hoping was a really nice indirect read for the joint wasn’t helpful. In the end, minor articular malreduction.