Abstract

VELUTINI BEKER, Ricardo; AZCONA CERVERA, Alberto  and  VELUTINI KOCHEN, José Antonio. Complication of a bilateral acetabular fracture after multiple surgeries and 30 years of evolution. Presentation of a case. Rev. sanid. mil. [online]. 2018, vol.72, n.2, pp.141-147. ISSN 0301-696X.

Bilateral acetabular fracture, open reduction and internal fixation, without achieving anatomical reduction; it required placement of short-term total prostheses, both cemented. We made a revision of both left hip components in the eighth year because of loosening of the cup and stem, with uncemented components. The femur evolved satisfactorily, but the acetabulum required six subsequent revisions, with bone grafts and placement of metal reinforcements, initially very stable, but with screw rupture and lack of osseointegration of both implants and grafts at 12 and 18 months in the different surgical events. She developed pseudoaneurysm of the left external iliac artery, treated by a vascular surgeon; it got complicated with local infection first and later, deep infection of the left hip by Staphylococcus aureus. The implants were removed from the iliac and polymethylmethacrylate with antibiotics was used to fill the large bone defect while the infection was being controlled, ending with a saddle rescue prosthesis (Link, Hamburg). It currently has a good function, without pain, but with limited mobility, especially flexion. The right hip has only been checked once; the acetabular cup began to migrate cephalically and vertically, but without losing stability, shortly after the loosening of the left one; it never developed femoral stem involvement, allowing acceptable function and being «her good leg» during the time of the left hip dysfunction. It was reviewed by placing a structural bone graft with two femoral heads from a corpse and cementing a new cup. The patient’s recovery has been very good, returning to an active life in which she is self-sufficient in all her daily activities; uses a crutch with her right hand, drives a van, is pain-free.

Keywords : Bilateral acetabular fracture; arthroplastic complications in young patients; infection; bone loss; block allograft; rescue prosthesis.