Associated Posterior Pelvic Injury Patterns in Transverse-Oriented Acetabular Fracture

Abstract

Objective: Our study analyzed the incidence of posterior pelvic injury patterns and their influence on the surgical treatment of transverse-oriented acetabular fractures . Methods:Fifty-one transverse-oriented acetabular fracture cases admitted between 1999 and 2013 were evaluated retrospectively. Comparative studies were performed for groups organized by acetabular fracture type, degree of sacroiliac separation, and postoperative reduction quality . Results: Associated posterior pelvic injuries were found in 34 (66.7%) of the 51 patients. There were 32 sacroiliac separations in the 34 patients with associated posterior pelvic injury, and ipsilateral sacroiliac separations were more frequent in this subgroup. Measurements guided by computerized tomography showed that 16 sacroiliac separations were ≤0.5 cm (mean=0.43±0.14 cm), 10 were 0.5-1 cm (mean=0.73±0.17 cm), and the remaining 6 were >1 cm (mean=1.55±0.15 cm). In the group of 34 patients with associated posterior pelvic injury, acetabular reduction was anatomic in 19 (55.9%) patients, imperfect in 10 (29.4%) patients, and poor in 5 (14.7%) patients. For isolated acetabular fractures, reduction rates were as follows: 12 (70.6%) anatomic, 3 (17.6%) imperfect, and 2 (11.8%) poor. The rate of anatomic reduction was significantly higher when sacroiliac separation was ≤0.5 cm (p=0.027) . Conclusion: Associated posterior pelvic injuries, especially ipsilateral sacroiliac joint separation, accompany most transverse-oriented acetabular fractures and may influence the quality of acetabular reduction. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

Three-dimensional mapping study of pure transverse acetabular fractures

“…Simple transverse fractures are traditionally regarded as transverse-oriented acetabular fractures according to the common concomitant disruption of the pelvic ring [ 5 , 24 , 25 ]. However, there is no clear theorem to confirm the impact direction during the fracture.…”

Systematic Review of Combined Pelvic Ring and Acetabular Injuries: What Do We Know From the Literature?

“…For acetabular injury, six used the Judet and Letournel classification [ 1 , 3 , 10 - 13 ], one used AO/OTA classification for the acetabulum [ 2 ], one used both Judet and Letournel and AO/OTA classification for the acetabulum [ 7 ], and three did not provide specific classification [ 4 , 8 - 9 ]. When possible, acetabular fractures were reclassified from Judet and Letournel to AO/OTA classification of acetabulum [ 10 - 11 , 13 ]. Of the 985 patients, 450 patients had an average Injury Severity Score (ISS) of 22.98 [ 1 - 2 , 7 - 8 , 11 - 13 ] Average ISS was calculated by the multiplication of each article’s individual sum cases by their ISS, adding the individual sums of all seven studies and then dividing by the total sum of 450 patients to collect the average of seven studies.…”

“…After the application of our defined eligibility criteria, a total of 18 studies were identified [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. One study was removed from our collected data due to duplicate data and six were removed as they did not meet inclusion criteria.…”

“…One study was removed from our collected data due to duplicate data and six were removed as they did not meet inclusion criteria. After initial exclusion, 11 articles remained with a total of 985 patients [1][2][3][4][7][8][9][10][11][12][13]. Of the 11, all were retrospective case series and the presence of both an injury within the pelvic ring and another injury within the acetabulum was the indication of a combination injury.…”

“…For pelvic injury, three studies used Young & Burgess to classify injury [1,[12][13][14], one listed injury without classification [10], three used both Young & Burgess and AO/OTA classification for the pelvis [2,7,13], and one used the Tile classification [3]. For acetabular injury, six used the Judet and Letournel classification [1,3,[10][11][12][13], one used AO/OTA classification for the acetabulum [2], one used both Judet and Letournel and AO/OTA classification for the acetabulum [7], and three did not provide specific classification [4,[8][9]. When possible, acetabular fractures were reclassified from Judet and Letournel to AO/OTA classification of acetabulum [10][11]13].…”