Results of operative treatment of acetabular fractures from the Third World—how local factors affect the outcome

Abstract

The objective of this study was to assess the outcome of operations on acetabular fractures from a developing country in the presence of locally available facilities. Sixty-three acetabular fractures were assessed at an average follow up of 52.94 months after operation. Twentysix patients operated upon in the first three years and 37 operated thereafter were separately studied to discover the effect of the learning curve. Regarding the fractures, 47 of 63 (74.6%) had excellent/good results (Harris Hip Score>80). The complications included broken drill bit in eight patients (12.69%), deep infection and heterotopic ossification in five patients (7.93%), avascular necrosis and sciatic nerve palsy in two patients (3.17%) and implant failure in one patient (1.58%). The results collected during the learning curve were inferior in the complex fractures (p value<0.001). Complications were common in patients opting for local implants and in those operated after over 2 weeks delay.Résumé Le but de ce travail est d'évaluer le traitement des fractures de l'accétabulum dans un pays développé. Matériel et méthode : 63 fractures de l'accétabulum ont été suivies en moyenne pendant 52,94 mois. 26 patients ont été opérés dans les trois premières années de notre expérience et les 37 autres patients opérés trois ans après que nous ayons commencé ce type de traitement, ceci afin d'évaluer de façon séparée les effets de notre courbe d'apprentissage. 47 sur 63 (74,6%) ont eu un excellent/ bon résultat avec un score de Harris supérieur à 80. Les complications ont été les suivantes : 8 fractures de mèches (12,69%), 5 infections profondes (7,93%) et 7 ossifications hétérotypiques (7,93%), 2 nécroses de la tête fémorale et 2 paralysies sciatiques (3,17%) une dans chaque groupe. Enfin, un débricolage chez un patient (1,58%). Les résultats selon la courbe d'apprentissage sont moins bons dans des fractures complexes (p<0.001) en début de pratique. Les complications sont plus habituelles chez les patients ayant bénéficié de la mise en place d'implants ou chez ceux opérés après 2 semaines de délai.

Drilling of Bone: Practicality, Limitations and Complications Associated with Surgical Drill-Bits

“…Intraoperative complications associated with the use of drill-bits includes drill-bit breakage (Fothi, Perren et al 1992;Hirt, Auer et al 1992;Benirschke, Melder et al 1993;Miller 2002;Price, Molloy et al 2002;Matthews, Landsmeer et al 2006;Bodner, Woldenberg et al 2007;Bassi, Pankaj et al 2008;Pichler, Mazzurana et al 2008;Gupta, Singh et al 2009;Kosy and Standley 2010) and heat generation (Berning and Fowler). Another cause for concern, albeit a rarely reported complication, is microfracture of host bone adjacent to the drilled defect.…”

Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture

“…Recently, Giannoudis et al have described a two-level reconstruction technique using subchondral miniscrews for the stabilisation of comminuted posterior-wall marginal acetabular fragments before applying lag screws and a buttress plate to the main overlying posterior fragment [5]. These levels of management demand extreme surgical skill, accuracy and infrastructure, which may be a limiting factor in many centres [7]. Again the orientation of the small fragments is sometimes difficult to assess [1,13].…”

Acetabular fractures labelled poor surgical choices: Analysis of operative outcome

“…25 The results published from developing countries earlier also report a similar incidence of infection suggesting that the factors leading to increased infection in our series might be attributable to causes like poor hygiene, poor infrastructure and operating room conditions as compared to the western world. 9 The inferences that can be drawn from the present study show that the complication rates in the acetabular injuries otherwise labelled as poor surgical choices are marginally higher as compared to the world literature for fractures which are recommended to be routinely operated. Although a longer follow up is required, midterm outcome suggests that in these fractures a satisfactory outcome can be achieved in more than 50% of cases, hence not all patients should be treated with a conservative approach which usually leads to an inferior outcome.…”

“…Our earlier report included majorities of simple fracture patterns in contrast to the present one which includes complex ones. 9 The availability of good imaging facilities, gain in surgical expertise, better instrumentation, novel advances in perioperative care together with our experience of uniformly poor results after conservative management led us to believe that the surgical fixation of these difficult fractures would yield better results that can be expected by conservative treatment alone. Neglected fractures (n ¼ 24) formed majority of the cases in these series.…”