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12 Sep 2025
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Sequential Reduction and Grafting of Comminuted Acetabular Fracture

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Clinical Details

Clinical and radiological findings:  The patient sustained a comminuted acetabular fracture with multiple chondrocancellous articular fragments. The injury pattern is consistent with an AO/OTA 62-B3 (both column) acetabular fracture. Initial radiographs and computed tomography demonstrated displaced intra-articular fragments with associated segmental bone loss and wall involvement. No neurovascular compromise was documented.

Preoperative Plan

Planning remarks:  The preoperative plan involved an extensile approach to the acetabulum, with the intention to carefully extract all chondrocancellous fragments for ex vivo cleansing, followed by dense packing of allograft bone grit into metaphyseal defects to support articular reconstruction. Sequential reduction of articular fragments was planned, followed by reduction and fixation of the acetabular wall using plate osteosynthesis.

Surgical Discussion

Operative remarks: 

All chondrocancellous fragments were meticulously removed from the wound and cleansed of hematoma and debris. Dense allograft bone grit was packed into metaphyseal defects to provide subchondral support. Each articular fragment was anatomically reduced and provisionally stabilized. The posterior wall was then reduced and definitive fixation achieved using contoured reconstruction plates. Attention was paid to restoring the congruity of the acetabular dome and maintaining anatomic reduction throughout the sequence.

Postoperative protocol:   Postoperatively, toe-touch weight bearing was instituted for 8 weeks, with passive and active-assisted range of motion exercises initiated on postoperative day one. Progression to partial weight bearing at 8 weeks, with full weight bearing as tolerated after radiographic evidence of healing.

Follow up:   Not specified

Orthopaedic implants used:   Contoured reconstruction plate(s), allograft bone grit

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Chip Routt
  • United States , Texas
  • Area of Specialty - Pelvis
  • Position - Specialist Consultant
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