Surgical treatment and prognosis of acetabular fractures associated with ipsilateral femoral neck fracture

Abstract

Objective To discuss the efficacy of open reduction and internal fixation in the treatment of acetabular fractures associated with ipsilateral femoral neck fracture.Methods From October 1990 to January 2008,5 male and 2 female cases of acetabular fractures associated with ipsilateral femoral neck fractures were treated with open reduction and internal fixation.Their mean age was 38 years.According to the Letournel classification,fractures involved posterior acetabular wall in 2 cases,posterior column plus posterior wall in 1,transverse acetabulum plus posterior wall in 2 and both columns in 2.According to the Garden classification,2 patients had type Ⅲ fracture and 5 type Ⅳ.Both X-ray films and CT scans showed 5 cases were associated with femoral head dislocation.Results All the 7 patients were followed up for 1 to 18 years (average,9 years).Postoperative X-ray films showed anatomic reduction of acetabular fracture in 5 cases and satisfactory reduction in 2 cases,as well as satisfactory reduction of femoral neck fracture in all the patients.Postoperative X-ray films also revealed necrosis of femoral head in the 5 patients who had femoral neck fractures and femoral head dislocation,but not in the other 2 who had no femoral head dislocation.Conclusions Total hip replacement should be the treatment of choice for patients who are complicated with femoral neck fracture and femoral head dislocation,because the rate of necrosis of femoral head is very high.For patients who have no femoral head dislocation,however,open reduction and internal fixation is the best choice for primary treatment. Key words: Acetabulum; Femoral neck fracture; Femur head necrosis; Fracture fixation,internal;  Prognosis