Long term results after surgical management of posterior wall acetabular fractures.

Narender Kumar Magu,Rohit Singla,Amanpreet Singh,Reetadyuti Mukhopadhyay,Rajesh Rohilla,Paritosh Gogna,Amit Batra

doi:10.1007/s10195-014-0297-8

Abstract

BackgroundPosterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome.Materials and methodsWe retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25–60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5–22 years) who met the inclusion criteria formed the study cohort. Matta’s criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d’Aubigné and Postel score.ResultsAnatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d’Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery.ConclusionAnatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures.Level of evidence(Level 4) Retrospective case series.

Highlights

Fracture of the acetabular posterior wall accounts for approximately one fourth to one third of all acetabular fractures [1,2,3]
Background Posterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation
Displaced acetabular fractures are best treated with anatomical reduction and stable internal fixation

Summary

Introduction

Fracture of the acetabular posterior wall accounts for approximately one fourth to one third of all acetabular fractures [1,2,3]. Displaced acetabular fractures are best treated with anatomical reduction and stable internal fixation. J Orthopaed Traumatol (2014) 15:173–179 ossification tend to result in poorer outcome despite good fracture reduction [5, 6] The purpose of this was to evaluate long term functional and radiologic outcomes in patients with posterior wall acetabular fractures to determine factors that may contribute adversely to satisfactory final outcome and to identify clinical situations that may be overlooked initially but may have serious consequences on final outcome. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome. Functional outcome at final follow-up was assessed according to d’Aubigneand Postel score

Methods

Results

Conclusion