Open reduction and internal fixation versus total hip arthroplasty for the treatment of acute displaced acetabular fractures.

Abstract

To The Editor: Regarding Acute Total Hip Arthroplasty for Selected Displaced Acetabular Fractures. Two to Twelve-Year Results (2002;84:1-9), by Mears and Velyvis, the indications for total hip arthroplasty for the treatment of acute acetabular fractures and the most reliable technique for achieving fixation of the socket are unclear. Why did the authors decide that intra-articular fractures with ten or more fragments had a poor prognosis? Why not five or eight fragments? On what radiographic view were these fragments counted? In the radiographs of the only patient under the age of thirty years who had a both-column fracture (Figs. 2-A, 2-B, and 2-C), I fail to recognize the multiple fragments mentioned in Table III. In the Discussion, the authors cited the experience of Letournel and Judet, who reported unfavorable outcomes associated with fractures of the anterior wall, the transverse-posterior wall, and the posterior wall-posterior column in comparison with the outcomes of other fracture patterns. However, if one compares Mears and Velyvis's rate of good to excellent results after total hip replacement for the treatment of acetabular fractures (79%) with the rates of such results after open reduction and internal fixation of fractures of the anterior column (78%) and the transverse-posterior wall (73%) 1, the results of open reduction with internal fixation are not substantially inferior to those of total hip replacement. Since the fracture classification was never meant to be prognostic of outcome but a tool for better understanding the anatomy of the fracture pattern and planning its reduction 2, the accuracy of the reduction should remain the standard in predicting outcome 3. As discussed by Mears and Velyvis, malreduction increases the risk of misplacement of internal fixation. How much nonanatomical reduction of the acetabular fracture is acceptable to minimize the risk of fixation misplacement? With regard to …