Outcome of surgery for reconstruction of fractures of the acetabulum

Abstract

This is a retrospective case review of 237 patients with displaced fractures of the acetabulum presenting over a ten-year period, with a minimum follow-up of two years, who were studied to test the hypothesis that the time to surgery was predictive of radiological and functional outcome and varied with the pattern of fracture. Patients were divided into two groups based on the fracture pattern: elementary or associated. The time to surgery was analysed as both a continuous and a categorical variable. The primary outcome measures were the quality of reduction and functional outcome. Logistic regression analysis was used to test our hypothesis, while controlling for potential confounding variables. For elementary fractures, an increase in the time to surgery of one day reduced the odds of an excellent/good functional result by 15% (p = 0.001) and of an anatomical reduction by 18% (p = 0.0001). For associated fractures, the odds of obtaining an excellent/good result were reduced by 19% (p = 0.0001) and an anatomical reduction by 18% (p = 0.0001) per day. When time was measured as a categorical variable, an anatomical reduction was more likely if surgery was performed within 15 days (elementary) and five days (associated). An excellent/good functional outcome was more likely when surgery was performed within 15 days (elementary) and ten days (associated). The time to surgery is a significant predictor of radiological and functional outcome for both elementary and associated displaced fractures of the acetabulum. The organisation of regional trauma services must be capable of satisfying these time-dependent requirements to achieve optimal patient outcomes.

Quadrilateral plate fractures of the acetabulum: An update

“…14,[62][63][64][65][66][67][68][69] The recorded outcome of these difficult fractures has significantly improved reflecting the increasing expertise and the advances of rehabilitation. 12,[18][19][20]27,43,46,70,71 Acetabular fractures with elements of displacement and/or comminution of the quadrilateral plate or medial wall remain challenging especially in the presence of osteoporosis. For that reason we performed the present comprehensive review to define the course of management of this element of an acetabular fracture.…”

“…18,20,22,29,46 This relates to several factors including the increased incidence of medial wall fractures, comminution, associated intra-articular chondral and osseous injuries, pre-existing osteoarthritis and gaining secure fixation in osteoporotic bone. 11,17,19,22 Other factors related to an unfavourable outcome include delay to surgery, 18,22,68 morbid obesity and medical co-morbidities. 22 The surgical approach to quadrilateral plate fractures is dependent on the fracture pattern, whether the quadrilateral plate remains attached to one of the columns or is a separate displaced or comminuted fragment, the column or wall which appears mostly displaced, the planned method of fixation, as well as the surgical expertise and preference.…”

“…3,20,22 Rates of heterotopic ossification range from 3% to 59%. 3,[18][19][20][21][22]29,79,80 Risk factors include the extensile approaches, high Injury Severity Score, delay in fixation and associated head injury. 20 In a metaanalysis of 3639 patients treated with ORIF 26.5% went on to develop osteoarthritis and 5.6% went on to develop avascular necrosis of the femoral head.…”

“…[11][12][13][14][15][16][17] These fractures of mainly the elderly population, also pose several specific treatment challenges compared to those of young high-energy trauma patients who are traditionally associated with acetabular fractures. 7,12,13,[18][19][20][21][22][23] Until the 1960s most acetabular fractures were treated nonoperatively. Traction was first recommended by Cottloda in 1922 and represented the mainstay of management.…”

Outcome after Surgical Management of Acetabular Fractures: A 7-Year Experience

“…The most studies reported good to excellent functional outcomes in 71-88% patients after surgical treatment of acetabular fractures [12][13][14][15]. The important prognostic factors to influence clinical outcome include associated fracture type, damage to the femoral head, associated injuries, dislocation at the time of injury, inadequate fracture reduction, age, development of heterotopic ossification, and a delay in surgical treatment [16][17][18][19][20][21]. In addition, the surgeon's training and expertise is a crucial factor [22].…”