Acetabular Fractures Treated Surgically: Which of the Parameters Affect Prognosis?

Abstract

BACKGROUND: This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis. METHODS:Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19-67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2-8 years) were performed at least for two years were included in this study. RESULTS:Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3% of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-square p<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher's p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patient was not effective on the clinical outcome (p=0.461). CONCLUSION:It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.

Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures

“…Male sex was identified as a risk factor for HO in only 1 of 10 studies (reported p < 0.01) 7,13,19,28,30-32,35,37,39 . Similarly, increased age was reported as a risk factor in 2 of 10 studies (reported p = 0.03, reported p = 0.007) 7,19,28,30,32,36,37,39,40,45 .…”

“…Surgical approach: Thirteen studies assessed the effects of the surgical approach on the development of HO 7,8,27,28,30,31,34-36,40,41,44,45 , with 9 reporting significant associations (Table II) 27,30,34-36,40,41,44,45 . The extended iliofemoral approach was reported to have the highest risk (reported p = 0.0002 [OR: 4.4, 95% CI: 2.0 to 9.4] versus the Kocher-Langenbeck and ilioinguinal approaches, and reported p = 0.011 versus the triradiate approach) 41,44 .…”

“…The Kocher-Langenbeck approach had the third-lowest risk (reported p = 0.049 versus the ilioinguinal approach) 40 , and the ilioinguinal approach had the lowest risk. One study identified inadequate fracture reduction (postoperative step-off of >3 mm) to be significantly associated with HO formation (calculated p < 0.01 [OR: 6.8, 95% CI: 1.7 to 26.8]) 36 . The use of a trochanteric osteotomy as part of the operative exposure was examined in 3 studies 14,28,37 , with 1 reporting significance (calculated p < 0.001 [OR: 78.0, 95% CI: 11.8 to 515.0]) 14 .…”

“…Nine studies investigated delay to surgery as a predictor of HO 7,28,30-32,36,37,39,40 , with only 2 reporting a significant relationship 37,40 . However, all studies represented low-quality evidence (Levels III and IV).…”

“…The extended iliofemoral approach was reported to have the highest risk (reported p 5 0.0002 [OR: 4.4, 95% CI: 2.0 to 9.4] versus the Kocher-Langenbeck and ilioinguinal approaches, and reported p 5 0.011 versus the triradiate approach) 41,44 . The triradiate approach had the second-highest risk (calculated p , 0.01 [OR: 16.1, 95% CI: 1.5 to 175.2]) versus the Kocher-Langenbeck approach 36 . The Kocher-Langenbeck approach had the third-lowest risk (reported p 5 0.049 versus the ilioinguinal approach) 40 , and the ilioinguinal 36 .…”