Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty

Abstract

Introduction: Acetabular fractures (AFxs) are rare injuries considering their incidence. The gold standard of treatment is open reduction and internal xation (ORIF). Surgical treatment represents a challenge for orthopedic surgeons. Our purpose is to assess the short-to medium-term functional outcomes and complications of surgically treated AFx. We analysed the factors in uencing clinical outcomes, the incidence of complications and the predictors of conversion in total hip arthroplasty (THA).Materials and Methods: We retrospectively analysed 102 patients with AFx treated between December 2017 and September 2020. The inclusion criteria were AFx treated with ORIF and more than 12 months of follow-up (FU). We evaluated the quality of reduction with X-ray measuring residual displacement, classi ed into 3 groups (Matta Radiological Score). Postoperative super cial and deep infections, neurological sequelae and deep vein thrombosis were documented. X-rays were performed to con rm the adequacy of xation and complications. At the nal FU, the radiographs were graded according to Matta's Radiological Outcome Grading, and the clinical outcomes were graded using the Oxford Hip Score (OHS).Results: Of 102 patients, 62 patients were enrolled. The statistical analysis revealed that OHS was in uenced by quality of reduction (P=0.033), injury severity score (ISS) (P=0.005) and age (> 75 years) (P=0.029). A signi cant correlation between the patient's BMI and the OHS was recorded. The late sequelae were heterotopic ossi cation (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was signi cantly affected by the posterior approach (P=0.031) and by an ISS > 15 (P= 0.0003). The analysis showed a correlation between AVN and posterior hip dislocation (P=0.004).OA had a correlation with postoperative quality of reduction (P=0.014). Eight patients required THA. Comparing patients with and without THA, a signi cant correlation between THA and posterior dislocation (P=0.022), isolated posterior wall fracture (P=0.039) and ISS > 15 (P=0.029) was recorded.Conclusion: Despite the improvement of surgical techniques and perioperative care, a high rate of patients with AFx still develop complications and require THA. Identifying negative predictors to help the management of fractures in elderly individuals is needed. Furthermore, the presence of negative predictors could represent an indication for primary THA.

No Difference in Acute Outcomes for Patients Undergoing Fix and Replace versus Fixation Alone in the Treatment of Geriatric Acetabular Fractures

“…Although younger patients presenting with acetabular fractures are a result of highenergy trauma, acetabular fractures among the elderly are because of low-energy falls. 2,3 Geriatric acetabular fractures typically present as displaced, comminuted fractures involving the anterior and posterior columns and are becoming increasingly prevalent. [4][5][6][7] Displaced acetabular fractures are often managed with ORIF; however, literature that includes patients from all age groups has shown mixed outcomes and long-term survival, with 13%-44% of patients developing post-traumatic arthritis and poor functional outcomes requiring further intervention.…”