Osteotaxis: a novel technique for the treatment of acetabular fractures

Acetabular fractures account for 3% of all fractures and typically result from high-energy trauma. Their management remains challenging owing to the complex three-dimensional anatomy of the acetabulum and the frequent association with other injuries. Conservative treatment entails prolonged hospitalisation and decubitus-related complications, whereas open surgical reduction is technically demanding and carries risks including heterotopic ossification, nerve injury and infection. During the COVID-19 pandemic, the need to shorten hospital stays and limit bed occupancy prompted the development of a novel percutaneous technique, termed Rahmi osteotaxis, for the treatment of displaced acetabular fractures.

Methods: We report a prospective series of twenty patients (fourteen men and six women; mean age 57 years) operated on for acetabular fractures in the Orthopaedic-Traumatology Department of Ibn Rochd University Hospital, Casablanca, over a five-year period. Fractures were classified according to Judet and Letournel, with six simple transverse and fourteen complex fractures, predominantly both-column patterns. The technique employs a Hoffmann-type external fixator with six pins placed percutaneously in the supra-acetabular, femoral neck and subtrochanteric regions, producing vector traction that achieves instantaneous and stable reduction under fluoroscopic control. Reduction quality was assessed using Matta’s criteria and the Duquennoy and Senegas classification; functional outcome was evaluated with the Postel and Merle d’Aubigné score.

Results: Mean operative time was 20 minutes with minimal blood loss. Reduction was satisfactory in sixteen cases and unsatisfactory in four. Vertical congruence was perfect in 60% and good in 40% of cases. All patients were discharged on the second postoperative day. The fixator was removed at six weeks, with full weight-bearing allowed from the third month. At a mean follow-up of four years, functional results were good in 80% of cases. One case of secondary coxarthrosis required total hip arthroplasty; no pin-site infection, deep vein thrombosis or secondary displacement occurred.

Conclusion: Rahmi osteotaxis is a safe, reproducible alternative to conservative treatment of displaced acetabular fractures, particularly valuable when major surgery is contraindicated or in damage-control settings.