Here is operative report:
Postoperative diagnosis: right posterior/superior dome acetabular fracture-dislocation with incarcerated intra-articular fragments.
Procedure: ORIF of right posterior wall and superior dome acetabular fracture
Description of procedure: ...Posterior wall fragments were comminuted, but were maintained in their alignments by capsular attachments. The posterior wall fragments were displaced. Capsular attachments were kept longitudinal and lateral traction was placed on the hip joint. A grasper was used to retrieve the large osteochondral fragment from the anterior joint. This fragment was teardrop shaped and was approximately
2.5 cm x 2 cm. There was another small osteochondral fragment with devitalized cartilage and cancellous bone and was not replaceable into the posterior wall. Copious irrigation was performed in the hip joint. Of note, the incarcerated fragment was positioned in the anterior joint such that there was articular cartilage of the femoral head. The posterior column and wall was exposed. Quadratus femoris was protected throughout the case. It took considerable amount of time to determine exactly where this osteochondral fragment came from. Finally it became evident that it keyed into the superior dome and anatomic reduction was obtained. The posterior wall fragments were then closed over the posterior column and osteochondral fragment.The posterior wall fragments with the capsule attachemtn had large osteochondral fragment attached to it. They were keyed in anatomically into the posterior wall and column. There were held with k-wires. A 6-hole acetabular plate was then contoured to the posterior wall and column. It was extended from ischium to ilium. It was secured with three 5 cortical screws in the holes. Excellent fixation was obtained. All screws were noted to be extra-articular. Direct lateral anterior oblique and continuous views were utilized.....
I know this is long and appreciate any suggestions.
Postoperative diagnosis: right posterior/superior dome acetabular fracture-dislocation with incarcerated intra-articular fragments.
Procedure: ORIF of right posterior wall and superior dome acetabular fracture
Description of procedure: ...Posterior wall fragments were comminuted, but were maintained in their alignments by capsular attachments. The posterior wall fragments were displaced. Capsular attachments were kept longitudinal and lateral traction was placed on the hip joint. A grasper was used to retrieve the large osteochondral fragment from the anterior joint. This fragment was teardrop shaped and was approximately
2.5 cm x 2 cm. There was another small osteochondral fragment with devitalized cartilage and cancellous bone and was not replaceable into the posterior wall. Copious irrigation was performed in the hip joint. Of note, the incarcerated fragment was positioned in the anterior joint such that there was articular cartilage of the femoral head. The posterior column and wall was exposed. Quadratus femoris was protected throughout the case. It took considerable amount of time to determine exactly where this osteochondral fragment came from. Finally it became evident that it keyed into the superior dome and anatomic reduction was obtained. The posterior wall fragments were then closed over the posterior column and osteochondral fragment.The posterior wall fragments with the capsule attachemtn had large osteochondral fragment attached to it. They were keyed in anatomically into the posterior wall and column. There were held with k-wires. A 6-hole acetabular plate was then contoured to the posterior wall and column. It was extended from ischium to ilium. It was secured with three 5 cortical screws in the holes. Excellent fixation was obtained. All screws were noted to be extra-articular. Direct lateral anterior oblique and continuous views were utilized.....
I know this is long and appreciate any suggestions.