Abstract
Objective To review long-term outcomes of surgical treatment of patients with acetabular fractures using an original outcome assessment questionnaire. Material and methods The study included 79 patients with acetabular fractures. The patients' age ranged from 16 to 67 years. Long-term follow-ups were evaluated with an original questionnaire measuring pain intensity, timings of primary surgery, reoperations including total hip replacement, technical details, accuracy of bone reduction/residual displacement and extent of restricted working capacity. Results Good and satisfactory long-term outcomes of acetabular fractures repaired with a primary surgery performed 22.7 ± 5.7 days of injury were observed in 43 (54.4 %) patients with complete bone reduction or 1–2 mm of residual displacement. Severe posttraumatic coxarthrosis, complications (avascular necrosis of the femoral head) or incomplete bone reduction with residual displacement of 2 mm to 2 cm detected in 36 (45.6 %) patients were rated as a poor outcome and required total hip replacement. Conclusion An active surgical approach to acetabular fractures employing open reduction and arthroplasties has shown to provide a good rehabilitation effect even for neglected cases with adequate restitution of the hip joint congruence ensured.
Highlights
Acetabular fractures constitute about 25 % of all pelvic injuries and result from high-energy trauma or polytrauma sustained in a motor vehicle accident (40– 76 %) or a fall from a height
Failure to timely diagnose an acetabular fracture and provide early surgical treatment within at least 10 days, application of nonsurgical modalities due to the severity of the condition, the complexity in restitution of topographic and anatomical relationships in the hip joint can often result in poor outcomes of surgical repair that are reported to be as high as 20-25 % even with the congruence achieved in the joint and treatment provided at specialized trauma wards
Posterolateral approach to the acetabulum (Kocher-Langenbeck) modified by Iselin was used for open reduction and osteosynthesis of the acetabulum with a reconstructive plate and screws day of admission/8 days of injury (Fig. 2)
Summary
Acetabular fractures constitute about 25 % of all pelvic injuries and result from high-energy trauma or polytrauma sustained in a motor vehicle accident (40– 76 %) or a fall from a height (up to 11 %). Failure to timely diagnose an acetabular fracture and provide early surgical treatment within at least 10 days, application of nonsurgical modalities (skeletal traction, plaster cast) due to the severity of the condition, the complexity in restitution of topographic and anatomical relationships in the hip joint can often result in poor outcomes of surgical repair that are reported to be as high as 20-25 % even with the congruence achieved in the joint and treatment provided at specialized trauma wards This can be caused by delayed reduction of the femoral head, arthritic hip, a variety of fracture patterns, excessive body weight and qualification of operating surgeons [7–9]
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