Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip

Abstract

We aimed to identify variables associated with clinical and radiological outcome following fractures of the acetabulum associated with posterior dislocation of the hip. Using a prospective database of 1076 such fractures, we identified 109 patients with this combined injury managed operatively within three weeks and followed up for two or more years. The patients had a mean age of 42 years (15 to 79), 78 (72%) were male, and 84 (77%) had been involved in motor vehicle accidents. Using multivariate analysis the quality of reduction of the fracture was identified as the only significant predictor of radiological grade, clinical function and the development of post-traumatic arthritis (p < 0.001). All patients lacking anatomical reduction developed arthritis whereas only 25.5% (24 patients) with an anatomical reduction did so (p = 0.05).The quality of the reduction of the fracture is the most important variable in forecasting the outcome for patients with this injury. The interval to reduction of the dislocation of the hip may be less important than previously described.

The surgical treatment of anterior column and anterior wall acetabular fractures

“…3,4,6,7,30,31,38 It has been shown that the quality of reduction assessed in the immediate post-operative period determines the development of osteoarthritis requiring total hip replacement. 1,2,24 In this case series, the post-operative residual displacement was < 3 mm in 28 of the 30 cases (93.3%), and at the time of final radiological assessment 9 20 of 26 (76.9%) maintained their good to excellent outcome. Two cases had an unsatisfactory reduction and a poor final radiological score, but reported good to fair function.…”

“…1,12,20,21 There is ample evidence that surgery for displaced acetabular fractures results in a favourable outcome. [21][22][23][24] To our knowledge, only the Letournel series 1 has so far provided substantial evidence on the outcome of individual simple acetabular fracture patterns such as anterior column and or anterior wall fractures. This can be attributed to their rarity and the fragmentation of experience between different trauma centres.…”

Surgical indications and perioperative planning in the treatment of acetabular fractures

“…[9][10][11][12] Asetabulum kırıklarının büyük çoğunluğu yük taşıyan tavanı ilgilendirir. Bu bölgedeki en küçük düzensizlik eklemdeki artroza gidiş sürecini hızlandırır.…”

“…Göreceli sık görülmelerine ve ortopedistlerin büyük bölümü tarafından cerrahi olarak tedavi edilmelerine rağmen büyük serilerde en kötü sonuç-lar yine göreceli olarak sık karşılaşılan bu kırıkla-ra bağlıdır. [9,10,12,17] Genel olarak BT incelemelerinde posteriyor duvar bütünlüğünün %50'sinden azının korunmuş olması kararsızlık işareti olarak kabul gör-müştür ve cerrahi endikasyonudur. [18] Ancak duvar bütünlüğünün %80'inin korunduğu posteriyor duvar kırıklarında da kararsızlık nedeniyle cerrahi uygulanabilir.…”

TOTAL HIP ARTHROPLASTY FOR ACETABULAR FRACTURES “Early Application”

“…paction of the posterior wall, [8,9] hip dislocation related to the posterior wall, [9,10] and femoral head injuries have been noted as poor results after internal fixation. [2,11] These complications increase the risk of neurovascular traumatization, loss of height, and aseptic and septic loosening.…”