Harrington classified periacetabular fractures associated with metastatic carcinoma. This can help determine the appropriate management. The author is from the University of California in San Francisco.
Parameters:
(1) possibility of resection for cure
(2) medial wall status
(3) status of lateral cortices and superior wall
|
Possibility of Resection for Cure |
Status Medial Wall |
Status of Other Walls |
Class |
|
no |
intact |
intact |
I |
|
no |
deficient |
intact |
II |
|
no |
deficient |
deficient |
III |
|
yes |
NA |
NA |
IV |
A Class IV tumor involves a solitary metastasis where resection is likely to remove the only remaining focus of tumor, resulting in patient cure.
In addition, the vascularity of the lesion should be considered. Highly vascular tumors may be associated with a high blood loss that may make surgery difficult. This possibility should be considered for:
(1) multiple myeloma
(2) colon adenocarcinoma
(3) pancreatic adenocarcinoma
(4) renal carcinoma
|
Class |
Management |
|
I |
conventional total hip replacement arthroplasty |
|
II |
protrusio shell surrounding a conventional prosthetic acetabular component, to transfer weight bearing load to the intact acetabular rim |
|
III |
problematic due to lack of adequate bony support to secure a weight-bearing prosthesis; may be attempted if large, threaded pins can be placed across the acetabular bed to support a protrusio cup and prosthetic acetabular component (see Figure 9 page 1622) |
|
IV |
local resection en bloc, including partial hemipelvectomy |
|
highly vascular |
consider embolization |
Specialty: Hematology Oncology, Surgery, general
