Closed right acetabulum fracture

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Male, 60 years old
In December 2009, A man, has fall from a height of three meters, he received a closed right acetabulum fracture. Also, the right foot fibular portion of the sciatic was injuried. At the end of January 2010 was performed operation: open reposition, metallic osteosynthesis of the right acetabulum, revision of the sciatic nerve - the integrity of the nerve was not broken, during visual inspection. AT postoperative period, there was no back flexion and the back surface sensitivity of the right foot. Since 2015, strong deterioration of the support function of the right lower limbs, it became necessary when walking to use crutches. He had gained weight due inactivity (height 170 cm, weight 110 kg).

In November 2016, he applied for medical assistance. Performed CT scan of the pelvic bones. When the virtual right acetabulum was scratched, the anteroposterior diameter was 62 mm (further shrinking led to a critical loss of bone mass).At the same time, there was a defect in the cranial region of the cavity. It was decided to take a standard inspection cup with a polyethylene friction pair, and a defect in the cranial region hollows fill individually made highly porous titanium augment.

At the end of January 2017, all our plans were implemented without any technical difficulties. The posterior-lateral access trough is highlighted, massive osteophytes are removed according to virtual planning. The acetabulum was shredded with a roller up to 62 mm, then, in the area of the defect of the trench roof, shading was done with a diameter of 54 mm for augment. A pre-individually made augment was fixed to the implantable cup with bone cement. Through the cup and the augment there was a single hole for the spongy screw 6.5 mm., Which was also used for fixing the cup to the bone. A single complex - an auditing cup and augment are installed using the press fit handle. Before this, the bone grafting of the bottom of the cavity is made with autograft bone (it was there a lot). Further, the cup was fixed with bone spongy screws. Endoprosthetics of the femoral component was performed without any features.

In the postoperative period, the metered load on the right leg is 6 weeks (just in case). the patient has been under observation for more than two years. He leads an active lifestyle, crutches for a long time does not use. The patient is a farmer - owns his own farm. He is lame on his right leg, but the support function of this limb is satisfactory (the patient can stand on one right leg). The sensitivity of the right foot has recovered, but the back flexion of this foot is absent. The patient has adapted and is satisfied with the result that was achieved.
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