Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

Keykhosro Mardanpour,Sourena Mardanpour,Maryam Rahbar,Nyosha Mardanpour,Mahtab Rahbar

doi:10.4236/ojo.2016.612049

Abstract

Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P < 0.004), fracture pattern (P < 0.004), displaced acetabular fractures (P < 0.005), associated injuries in lower extremity (P < 0.005), finally post-surgery complications (P < 0.001) and adequate physical therapy (0.004) adversely affected the final functional outcome. Deep Vein Thrombosis and Pulmonary Embolism were seen in 6 patients, Avascular Necrosis in 4, local Infection in 6, Heterotopic ossification in 4 and post-traumatic degenerative joint in 5 and sciatic neurapraxia in 2. Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.

Highlights

Major pelvic injuries are predominantly occurred following road traffic collision [1]
We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures
A total of 200 patients who presented with displaced complex acetabular fractures of more than 2 mm within 10 days of injury have been included

Summary

Introduction

Major pelvic injuries are predominantly occurred following road traffic collision [1]. The incidence of pelvic fracture resulting from blunt trauma increases with obese patients [11]. Associated injuries were common and most of the fractures operated in our service came [12]. Peltier reported an incidence of 24% acetabular fractures in his series of adult pelvic fractures. Numerous factors, including fracture type and/or dislocation, femoral-head status, intra-articular osteochondral fragments, injury duration, reduction quality, local complications, associated injuries and surgical approach influence on results [29] [30]. Osteoarthritis of the hip joint, avascular necrosis of the femoral head and heterotopic ossification lead to poor functional outcome despite good fracture reduction and internal fixation [31] [32]. The present study reports results at 10 years follow-up, with an analysis of ORIF management in patients with complex acetabular fractures and determine factors that may contribute adversely to satisfactory functional outcome

Methods

Results

Conclusion