Abstract
Introduction:Approach to the management of displaced acetabular fractures has evolved from conservative to operative management after the work of Judet and Letournel. Various surgical methods have been explored and described by authors to address this type of fracture, leading to improved clinical outcome. This study aimed to evaluate functional outcome of surgically treated displaced acetabular fractures in the Malaysian context.Materials and methods:We analysed 43 patients with isolated acetabular fractures who were treated operatively with a minimum of three years follow-up. Anthropometric data, Judet-Letournel fracture pattern, surgical approach and complications were recorded. Post-operative Matta radiological outcome were evaluated for joint congruency and hip functional outcome was evaluated using Merle d’Aubgine-Postel and Harris Hip Score (HHS). All statistical analyses were analysed using SPSS version 24.0.Results:The most frequent elementary fracture type was posterior wall (30.2%) while associated type was both columns (23.3%). Mean functional outcome of Merle d'Aubigné-Postel was 15.77 and HHS was 86.6. Thirty-three (76.7%) patients achieved satisfactory functional outcome, 19 (44.1%) patients achieved anatomic reduction (<2 mm step-off) based on Matta classification while 24 (55.8%) did not achieve the desired outcome. Fracture pattern exhibited strong association with post-operative Matta radiological outcome (p-value 0.001). However both fracture pattern and Matta radiological outcome did not exhibit association with the functional outcome group. The mean time for surgical interventions was 10.8 days and there was no significant association with final functional outcome score.Conclusion:Fracture pattern is a strong contributing factor towards post-operative Matta radiological outcome. However, achieving the perfect anatomical reduction is not of utmost important factor to predict the good functional outcome.
Highlights
IntroductionPost-operative Matta radiological outcome were evaluated for joint congruency and hip functional outcome was evaluated using Merle d’Aubgine-Postel and Harris Hip Score (HHS)
Approach to the management of displaced acetabular fractures has evolved from conservative to operative management after the work of Judet and Letournel
Our study found that posterior wall fracture was the commonest type of fracture pattern, accounting to 30.2% followed by both column fractures, 23.3% and transverse with posterior wall fracture, 18.6%
Summary
Post-operative Matta radiological outcome were evaluated for joint congruency and hip functional outcome was evaluated using Merle d’Aubgine-Postel and Harris Hip Score (HHS). Fracture pattern exhibited strong association with post-operative Matta radiological outcome (p-value 0.001). Data for the prevalence of the acetabular fractures in South East Asia, in Malaysia are scarce These types of fractures are usually the results of high-energy trauma i.e., road traffic accidents or falls from height, which are often associated with other life-threatening injuries such as intracranial bleed, intrabdominal and lung injuries[3]. Usual complications resulted from the approaches such as, 20% to 25% of the patients are with poor functional outcomes in the medium-term follow-up such as concentric reduction of hip, articular surface congruency, and loss of femoral head blood supply as the ultimate outcome, including degenerative changes in the hip joint[3,4]. If the fractures are left unreduced, patients with displaced acetabular fractures are at risk of developing early hip osteoarthritis[5]
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