As an unusual traumatic presentation, acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture: a retrospective case series of 18 patients

Abstract

Background Acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture has been suggested as an unusual traumatic presentation and rarely reported in the literature. The aims of this study were (1) to identify the etiological characteristics, (2) to summarize the treatment strategy, and (3) to present the mid- to long-term results of patients with this rare traumatic presentation. Methods In this retrospective study, 18 patients (15 males, 3 females; mean age = 42.77 ± 17.74 years, range = 16 to 87 years) who were diagnosed and treated for simultaneous acetabular fracture and ipsilateral intertrochanteric fracture were included. Injury mechanisms, fracture classifications, and treatment strategies were noted. To assess functional status, the Harris score was used. To evaluate pain intensity, visual analogous scale (VAS) was used. The reduction quality of acetabular fractures was examined as per Matta’s standard. Postoperative complications were also recorded. Results The mean follow-up was 10.04 ± 3.38 (range = 6.2 to 16 years). The most common injury mechanism was traffic accident, followed by falling from a tall height. As per the Evans classification, intertrochanteric fractures were defined as type 3 in 13 patients, type 2 in one patient, and type 4 in 4 patients. In acetabular fracture site, the most common fractures were posterior wall fractures, followed by anterior column fractures. All patients received internal fixation for their intertrochanteric fractures. Ten out of 18 patients also received internal fixation for their acetabular fracture. However, for the remaining patients, acetabular fractures were treated conservatively or with fracture fragment resection. Bony healing was achieved in all but one patient who died postoperatively. Twelve patients achieved excellent and good results (Harris score ≥ 80 points) whereas five patients achieved fair and poor results (Harris score < 80 points). The proportion of patients who achieved an excellent-good Harris score was 70.6%. Dislocation of the hip was found to be an independent risk factor (HR = 9.194, 95% CI = 1.024-82.515) for the poor patient outcome. Conclusion To sum up, high-impact trauma is the main cause of acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture. For patients who have undergone surgical treatment, fracture healing is usually achieved. However, the occurrence of complications, especially avascular necrosis, is the major cause of a poor prognosis. Dislocation of the hip joint at the time of injury is considered to be an important risk factor for a poor prognosis.

Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modified Stoppa Approach in Treating Pelvic and Acetabular Fractures

“…This helps in better application of the reduction force to the ischial margin and thereby achieve the best reduction effect in the treatment of quadrilateral plate fracture rotation displacement. The results of this study also showed that the operation time, incision length, blood loss, and hip function score of the pararectus approach group were significantly better than those of the modified Stoppa approach, which further confirmed the important application value of this approach in the surgical treatment of complex pelvic acetabular fractures [ 14 , 16 , 17 ].…”

Outcome of acetabulum fractures treated with open reduction and internal fixation through Kocher-Langenbeck Approach: A retrospective study

“…Previous studies have reported that males were more likely to be affected with acetabular fractures. 5,16,27,28 In this study, mostly males (60%) were found to be affected with acetabular fracture which may be attributed to outdoor activity. A number of studies have shown that road traffic accident is a major mechanism of acetabular fracture.…”

The floating hip injury: a descriptive study and case-control analysis

“…Similar observations have again been corroborated in previous literature. 9 , 12 Whenever surgical management of P/A fractures was deemed necessary, the femur was often fixed first, an order observed in most other case series as well. The beneficial effects of earlier fixation of femoral fractures are thought to stem from the increased physiological and mechanical stability; earlier stabilisation of the femur facilitates enables a stable platform for better positioning, exposure and reduction of P/A fractures, reduces the occurrence of significant bleeding, lowers fat emboli risks, and may also help patients achieve earlier mobilisation.…”

“… 5 , 8 , 9 A growing number of studies have described their encounters with this rare injury. 5 , 10 – 13 However, many studies to date have either only reported case-series of limited numbers, or have offered no form of controlled comparison to similar P/A injuries without femoral involvement.…”