Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

Abstract

Background Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown. Materials and Methods A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes. Results Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13–84) and mean follow-up was 19.8 months (range 1.5–56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%). Conclusions Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.

Double Trouble: Exploring Bilateral Acetabular Fractures in a Trauma Patient

“…In previous studies that analyzed the most common types of acetabular fractures based on the Letournel and Judet classification system, high-velocity acetabular fracture groups commonly presented with posterior wall and transverse posterior wall fractures. Bilateral acetabular fractures from high-velocity accidents most commonly presented with bilateral transverse posterior wall fractures or posterior wall and anterior wall fractures in 18% and 14% of cases respectively [ 1 ]. Our patient presented with associated column fractures on the right and posterior + anterior wall fractures on the left.…”

“…Past studies show most acetabular fractures have associated injuries due to the high-velocity nature of the fractures. The most commonly associated injury is in the lower extremity, followed up upper extremity (as seen in our patient), and pelvis/spine [ 1 , 5 ]. Acetabular fractures secondary to high-velocity injury are also associated with hip dislocation requiring emergency reduction [ 6 ].…”

“…A recent review of bilateral acetabular fracture cases showed that 45% of cases underwent ORIF, 40% were treated conservatively, and 15% underwent total hip arthroplasty (THA) [ 1 ]. ORIF remains the “gold standard” treatment for both unilateral and bilateral acetabular fractures.…”

“…Bilateral acetabular fractures represent a rare and formidable subset of pelvic injuries, typically stemming from high-energy trauma incidents, and often accompanied by significant morbidity [ 1 , 2 ]. The complex anatomical structure of the acetabulum, which serves as the primary weight-bearing surface for the hip joint, comprises an anterior column and a posterior column.…”

Effects of Different Surgical Procedures on the Therapeutic Effects, Prognosis, and Major Complications of Acetabular Fractures in the Elderly of China: A Systematic Review and Meta-Analysis

“…In the 1860s, Yu et al [ 24 ] took the lead in proposing surgical treatment of acetabular fractures in the elderly, which was supported and imitated by many scholars, and achieved good results. The scholars performed statistical classification on 120 elderly patients with acetabular fractures [ 25 ]. As the patients' age increased, their prognosis became worse and worse, but they still had a high excellent and good rate.…”