Browsing by Author "Shataayu Gugale"

Now showing 1 - 2 of 2

Optimizing surgical management of acetabulum fractures involving both columns using buttress plating of posterior column through AIP approach
(Elsevier B.V., 2024) Sandeep Kumar; Shataayu Gugale; Rohit Goyal; Akash Mishra; Vivek Bhambhu; Ganpat Choudhary
Introduction: Acetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns. Materials and methods: Between 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months–70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test. Results: The study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients. Conclusion: We conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall. © 2024 Delhi Orthopedic Association
Survivorship of hip after acetabulum fracture fixation – Analysing risk factors associated with early THR
(Elsevier B.V., 2025) Sandeep Kumar; Priya Yadav; Akash Mishra; Shataayu Gugale; Rohit Goyal; Vivek Bhambhu
Introduction: Acetabular fracture fixation principles stated by Letournel and Judet have contributed significantly towards advancement in treatment methodologies. Current day techniques helps to achieve anatomical reduction, still post-traumatic arthritis ensues in some patients. A meta-analysis by Giannoudis et al. revealed osteoarthritis incidence of 13 % in patients with satisfactory reductions (<2 mm) and 44 % with unsatisfactory reductions (>2 mm). Predicting poor outcomes before treatment could improvise patient counselling and treatment selection. This study aims to assess the functional outcomes and analyze risk factors for early total hip replacement (THR) in acetabulum fractures. Materials and methods: From 2017 to 2024, 560 patients with acetabulum fractures were managed surgically. Out of them 316 had more than 2 years follow up, and were included in this study. Fracture patterns involved 5 elementary and 5 associated types, treated through various surgical approaches and followed up for an average of 3 years. Data collection included demographics, lab investigations, radiographs, and CT scans. Statistical analysis using SPSS version 29.0.2.0 employed Chi-square tests, Fisher's exact tests and Cox proportional hazards regression to identify significant predictors of THR, with P-values <0.05 considered significant. Results: The study involved 316 patients, with a mean age of 43 years, followed up for 2–7 years. 81 % were males. Most fractures were T-type (17.1 %) and treated using the Modified Stoppa Approach (43.7 %). Anatomic reduction was achieved in 77.2 % patients. Overall, 75.3 % patients had excellent to good outcomes. 32 (10.12 %) of the patients were converted to THR, while 46 (14.5 %) had fair outcomes, and were considered as cases of impending THR. Significant predictors for THR included age, surgical delay, fracture pattern and reduction quality. Age 60 and above, and poor reduction quality were associated with higher THR rates (Hazard ratio = 1.00). Conclusion: Survivorship of the hip joint post-acetabulum fracture is influenced by age, fracture pattern, surgical delay, and post operative reduction quality. Addressing modifiable factors such as anatomical reductions of the fracture and surgical intervention within one week of injury are crucial for improving long-term outcomes, further reducing the need for THR after acetabular fracture fixation. © 2024 Delhi Orthopedic Association