Semiprone Position for Posterior Approaches to Acetabular fractures Allows Intuitive Radiographic Acquisition and Versatility for Surgical Hip Dislocation: A Technical Note and Preliminary Report

BackgroundAlthough the pros and cons of prone and decubitus positioning methods, for posterior approaches to acetabular fractures, have been widely discussed, it remains inconclusive whether a particular patient position is superior to the other. Here we present our preliminary experience with placing the patient in the semiprone position for posterior approaches to the acetabulum as a potentially advantageous alternative.MethodsTechnical notes were provided as well as the preoperative, intraoperative and postoperative images of the demonstrative cases. From July 2018 to April 2020, eight selected patients with complex acetabular fractures were surgically treated through posterior approaches in semiprone position. Patient demographics, fracture pattern, poor prognostic factors and associated conditions were recorded. The quality of fracture reduction was assessed by Modified Matta’s criteria. The operative hip’s function was evaluated by the Modified Merle d’Aubigné-Postel score if follow-up was more than 3 months.Result:The Median age of our cohort was 48.55 years (24.3–70.6). The median body mass index was 23.90 kg/ m2 (17.6–26.4). Satisfactory reduction was achieved in 6 of the 8 patients. Intraoperative radiographs obtained by the standard vertical and horizontal projection of the C-arm machine resembled the classic Judet views. Trochanteric flip osteotomy and surgical hip dislocation were feasible. One hip was converted to total hip replacement 5 months after primary fracture surgery due to femoral head osteonecrosis.Conclusion:The preliminary radiographic and reduction quality of our cohort were comparable to those reported in the literature. The advantages of semiprone position include intuitive intraoperative radiographic acquisition, making gravity as a aid for reduction and feasibility of surgical hip dislocation. Long-term follow-up and further case-controlled or randomized controlled studies are necessary to uphold its value.