Neglected acetabular fracture: Fix or replace?

Abstract

Operative treatment of acute acetabular fractures has shown better results than the non-operative approach. There is, however, limited data regarding the operative treatment of neglected acetabular fracture. We present six subjects with neglected fracture of the acetabulum in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia. One had only open reduction and internal fixation, three had open reduction and internal fixation first before we performed arthroplasty later, one had both open reduction and internal fixation with arthroplasty, and another had immediate arthroplasty. Our subjects were 4 males and 2 females with the average age of 41.1 years and the average neglect period was 18 months. In four of our subjects, the fractures had posterior wall involvement, one had an anterior column-posterior hemitransverse fracture, and the last one had transverse fracture. All fractures were classified to either Elementary or Associated type according to the Letournel classification. We observed all subjects up to eighteen months post-operatively. One subject had poor outcome, four subjects had fair outcome, and one subject had excellent outcome according to the Harris Hip Score. Even in neglected acetabular fracture, open reduction and internal fixation where possible should be attempted to restore the anatomical relationship to facilitate immediate or late total hip arthroplasty. Surgical treatment of such fractures should be based on individual case characteristics, which includes age, associated comorbidity, neglect period, as well as the type and union state of the fracture for a better outcome. Neglected Associated acetabular fracture types are more difficult to reduce and have poorer outcome compared to Elementary types. Likewise, malunited acetabular fractures are more difficult to operate on than non-united neglected acetabular fractures, where reduction is relatively easier.