Background
Incidence
Osteoarthritis
- abnormal morphology
- loss of head neck offset
- bony impingement on acetabulum
AVN
Unstable injuries
Complete disruption of both the anterior and posterior ring
5 - 20% of pelvic fractures
Axial load
Motor vehicle accident
Fall from height
Anterior ring
Subscapularis failure
Rotator cuff failure
Instability
Infection
Periprosthetic fracture
Aseptic loosening
Neurological injury
Parada et al. J Should Elbow Surg 2021
- 2224 aTSA complication rate 11%, revision rate 5.6%
RA
OA
AVN
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
Poor soft tissues
- prohibit ORIF
Non union
Infected non uniion
Malunion / deformity
Bone loss / bone transport / LLD
Metaphyseal
Extra-articular
< 60 with good bone stock and preserved joint space
Union rates increased with anatomical reduction
Options
- closed reduction
- open reduction / if closed reduction fails
Accept
- no varus
- < 15o valgus
- < 10o AP plane
Garden 1 / 2
ORIF
- ~ 15% displacement rate with non operative management
- increased risk of non union
- reduced hospital in patient stays
Cannulated screws
DHS + derotation screw