Vertical Shear
Definition
Unstable injuries
Complete disruption of both the anterior and posterior ring
5 - 20% of pelvic fractures
Mechanism
Axial load
Motor vehicle accident
Fall from height
Pathology
Anterior ring
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
Patient > 70
Gjertsen et al JBJS Am 2010
- 4335 patients > 70 with displaced subcapital fractures
- minimum 1 year follow up
- 1 year mortality same in each group / 25%
- 22% reoperation in ORIF v 3% in hemiarthroplasty
- more pain / higher dissatisfaction / lower quality life in ORIF group
Hemiarthroplasty
- unipolar monoblock
- unipolar modular
- haemarthrosis
- DVT
- infection
Incidence
Femur
Multiplanar deformity
- worsend by previous surgery
- may require osteotomy
Acetabulum
Dysplasia often present
- not as severe as in DDH
LLD
Can be significant
Abductors
Have been short for long time
- difficult to restore length