Minimally invasive surgical treatment of minimally displaced acetabular fractures does not improve pain, mobility or quality of life compared to conservative treatment: a matched-pair analysis of 50 patients

Benedict Swartman,Paul Alfred Gruetzner,Sven Yves Vetter,Jochen Franke,Holger Keil,Marc Schnetzke,Nils Beisemann,Johanna Pelzer

doi:10.1186/s13018-020-01611-y

Abstract

BackgroundCurrently available procedures for the treatment of minimally displaced acetabular fractures include conservative treatment and minimally invasive percutaneous screw fixation. Screw fixation of acetabular fractures allows patients’ early full-weight bearing due to improved biomechanic stability. Can the range of motion, pain and mobility and quality of life in patients with acetabular fractures be improved by minimally invasive screw fixation, compared to conservative treatment in the long term?MethodsPatients treated for a minimally displaced acetabular fracture, either conservatively or by closed reduction percutaneous screw fixation, in the period from 2001 to 2013 were included in this retrospective study. Minimal displacement was considered to be less than 5 mm. As well as the collection and analysis of baseline data, Harris Hip Score, Merle d’Aubigné score and Short Form 12 (SF-12) questionnaire data were recorded in the context of a clinical study. To better account for confounding factors, patients of each group were matched. The matched-pair criteria included age, BMI, Letournel fracture classification and the presence of associated injuries.ResultsTwenty-five patients from each group were matched. On the Harris Hip Score, conservatively treated patients obtained 96 points (52–100, SD 17) vs. 89 points (45–100, SD 17, p = 0.624). On the Merle d’Aubigné score, conservatively treated patients obtained 17 points (10–18, SD 2) vs. 17 points (11–18, SD 2, p = 0.342).Patients with acetabular fractures treated by minimally invasive screw fixation did not result in improved quality of life, measured by SF-12 questionnaire, compared to conservatively treated patients (PCS 47, SD 9 vs. 44, SD 10; p = 0.294 and MCS 51, SD 7 vs. 53, SD 7; p = 0.795).ConclusionsThe clinical results of the two groups revealed no statistically significant differences. From the data, it cannot be deduced that minimally invasive surgical therapy is superior to conservative treatment of minimally displaced acetabular fractures. Prospective randomised studies are recommended to allow reliable evaluation of both treatment options.Trial registrationRetrospectively registered

Highlights

Available procedures for the treatment of minimally displaced acetabular fractures include conservative treatment and minimally invasive percutaneous screw fixation
It cannot be deduced that minimally invasive surgical therapy is superior to conservative treatment of minimally displaced acetabular fractures
The uniformly advocated gold standard in displaced acetabular fractures according to the literature is open reduction and internal fixation [1, 3,4,5,6]

Summary

Introduction

Available procedures for the treatment of minimally displaced acetabular fractures include conservative treatment and minimally invasive percutaneous screw fixation. Can the range of motion, pain and mobility and quality of life in patients with acetabular fractures be improved by minimally invasive screw fixation, compared to conservative treatment in the long term?. The uniformly advocated gold standard in displaced acetabular fractures according to the literature is open reduction and internal fixation [1, 3,4,5,6]. The minimally invasive surgical approach is gaining increasing significance. Conservative treatment appears to be at least a therapeutic option with satisfactory clinical results in particular in the area of minimally displaced acetabular fractures [15, 16]

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