Analysis of operative treatment of displaced transverse acetabular fracture involving weight-bearing dome.

Abstract

Objective To retrospectively analyze the results of operative treatment of displaced transverse acetabular fracture involving weight-bearing dome and relative factors affecting clinical results. Methods From May 1990 to July 2006, 37 patients with displaced transverse acetabular fracture involving weight-bearing dome were surgically treated, which included 26 males, 11 females, with the mean age of 34 years (range, 22-64 years). The patients were grouped as reduction quality, comminuted level of fracture, hip stability and cartilaginous damage of the femoral head. The clinical results were evaluated according to Mat-ta' reduction criterion, radiographic evaluation criterion, and modified Merle d'Aubigne and Postel clinical e-valuation standard. Results All the patients were followed up with an average 88.6 months (range, 16-121 months). The quality of reduction was graded as anatomical reduction in 31 patients, imperfect reduction in 4, unsatisfactory reduction in 2. Two hips were diagnosed as instability in X-ray. According to modified Mer-le d'Aubigne and Postel clinical evaluation standard, the clinical outcome was graded as excellent in 16 pa-tients (43.24%), good in 14 (37.84%), fair in 4 (10.81%), poor in 3(8.11%). The excellent and good rates in clinical outcome were 81.08%. The final Motto X-ray results were graded as excellent in 14 patients (37.84%), good in 15 (40.54%), fair in 4 (10.81%), poor in 4(10.81%). The excellent and good rates in X-ray results were 78.38%. There was a strong correlation between the clinical outcome and X-ray results. Ex-cellent and good rates in anatomical and nonanatomical reduction group were 90.32% and 33.33% respec-tively; Excellent and good rates in simple dome fracture and comminuted dome fracture group were 92.00% and 58.33% respectively; Excellent and good rates for hip instability and stability group were 0 and 85.71% respectively; Excellent and good rates in cartilaginous damage and non-cartilaginous damage of the femoral head group were 42.86% and 90.00% respectively. Conclusion Comminuted fracture of dome, poor frac-ture reduction, potential instability of hip, combined cartilaginous damage of the femoral head are risk factors influencing clinical outcome of displaced transverse acetabular fracture involving weight-bearing dome. Key words: Acetabulum; Fractures; Fracture fixation, internal