The use of an Antiprotrusio Cage in Acetabular Reconstruction for Periprosthetic Transverse Fracture through a Direct Anterior Approach: A Case Report
Bibliographic record
Abstract
Introduction: Periprosthetic acetabular fractures following total hip arthroplasty (THA) represent a rare but challenging condition, particularly in patients with previous surgeries through the direct anterior approach (DAA). The case described is, to our knowledge, the first report of a central dislocation of the acetabular component treated using a Burch-Schneider anti-protrusion cage through an extensile DAA. This surgical choice was aimed at minimizing instability and optimizing exposure in a complex revision setting, thus offering an innovative contribution to the orthopedic literature. Case Report: A 64-year-old Caucasian female affected by ischemic vascular transverse myelopathy leading to asymmetric paraparesis, with greater involvement of the right lower limb, presented after a fall on her previously operated left hip. She underwent THA 2 years earlier. Radiological evaluation revealed a transverse acetabular fracture with medial cup migration and an associated Vancouver AG fracture. Given the patient's reliance on the left limb for mobility and the risks of instability from multiple surgical approaches, the revision was performed through an extensile DAA. An antiprotrusio cage specifically designed for anterior implantation was used, and the femoral component was preserved. Early mobilization was initiated postoperatively, with the patient regaining pre-injury mobility within 6 months. Conclusion: This case demonstrates the feasibility and benefits of using the extensile DAA in managing complex acetabular defects with a Burch-Schneider antiprotrusio cage. It highlights a surgical strategy that may reduce the risk of instability and improve functional outcomes in selected patients. The originality of this case lies in the use of an anterior approach to address a complication with a reconstruction technique typically reserved for posterior approaches. This report contributes to expanding the surgical options in revision hip arthroplasty and provides new insights into optimizing care in patients with complex anatomical and functional constraints.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".