Management Of Acetabular Fractures Research Articles

Correlation Between Radiological and Functional Outcomes Following Operative and Nonoperative Management of Acetabular Fractures: A Prospective Observational Study.

The management of acetabular fractures is a complicated orthopedic procedure that has been advancing with time. Newer radiological tools like CT scans help surgeons to identify and manage these fractures more attentively. The study was conducted to evaluate the clinical and radiographic outcomes in patients with acetabular fractures managed either conservatively or by open reduction and internal fixation. The study was done on 35 patients aged 18-60 years, with acetabular fractures treated either surgically or conservatively. Clinical scorings and radiological scoring were only taken and noted at three- and six-monthintervals using Matta's radiographic scoring and modified Merle d'Aubigne and Postel clinical hip scoring. Clinico-radiological variables and complications were compared between the two groups. The data obtained was subjected to statistical analyses using IBM Statistical Package of Social Sciences (SPSS) 2.0 version software (Chicago, IL, USA) at a level of significance being p<0.05. Out of a total of 35 patients, 19 were treated surgically and 16 conservatively. In patients belonging to the surgical treatment group, a maximum of 57.9% were aged 40-50 years, whereas the maximum patients (50%) of the conservative treatment group were aged <40 years, with male predominance in both groups. The type of fracture was recorded according to Judet and Letournel in both groups. Merle d'Aubigne's scoring and Matta's hip score were recorded at three and six months in both groups. A positive correlation was seen between radiological and functional outcomes at three and six months, which means that the higher the radiological scoring, the better the functional outcome of the patient managed either conservatively or surgically in the entire cohort. Our study revealed that surgically managed patients hadbetter functional and radiological outcomes than the patients who were conservatively managed at six months of follow-up. However, this is associated with more complications depending on fracture complexity and initial presentation of hip dislocation. The higher the radiological scoring, the better the functional outcome of the patient managed either conservatively or surgically in the entire cohort.

Surgical management of acetabular fractures associated with pelvic ring disruption, the time-dependent effect of delay

Background: Associated fractures of the acetabulum and pelvic ring represent considerable percentage of polytrauma victims. These types of injuries are different from isolated acetabular or pelvic injuries regarding injury severity scores, haemodynamic status, blood transfusion requirements, and higher mortality rates up to 13%. Both Letournel and Matta have definitively shown that anatomic reduction of the fracture is the most influential factor predictive of clinical outcome. The ability of obtaining anatomical reduction is affected by age, fracture pattern, associated injuries, patient general condition, timing to surgery and complications. Design: Retrospective cohort study. Methods: It is a retrospective study among 24 patients performed in Zagazig university hospitals between May 2017 and February 2019. Matta scoring system was used to quantify the radiological outcome of both acetabular and pelvic components while, both Majeed and Merle d’Aubigné were used for clinical grading at the final follow up. Timing to surgery was found to affect the quality of reduction significantly. Results: We divided our cases into 2 groups; First group including the patients underwent operative management from day 0 to day 10 which include 18 cases and Second group including the patients underwent operative management from day 11 to day 21 which include 6 cases and we will observe if there is a correlation between the preoperative delay and Matta scoring for both acetabular and pelvic components. Among the operatively managed acetabular fracture There was significant association between preoperative delay and Matta scoring system for acetabular component (P&lt;0.05) Among the operatively managed pelvic ring injuries There was significant association between preoperative delay and Matta scoring system for pelvic component (P&lt;0.05). Conclusion: The quality of reduction can be controlled by controlling the time to surgery after optimization of the general condition of the patient and controlling the local complications. In our study the earlier to operate on both components within the first 10 days after initial trauma the better to get anatomical reduction.

Medial surface plating of posterior column through the anterior intrapelvic approach in acetabulum fractures with involvement of both columns.

Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d'Aubigné score and Matta's radiological grading at one year and at latest follow-up. Immediate postoperative radiological Matta's reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d'Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta's radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d'Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta's radiological grading at latest follow-up also remained unchanged. Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window.

Surgical Management and Functional Outcome of Acetabular Fractures – A Prospective Study

Context: Acetabulum fractures are commonly a result of high-velocity road traffic accidents and falls from height. These fractures were previously treated nonoperatively which had led to high morbidity causing secondary osteoarthritis, limping, instability, and chronic pain. Aims: To surgically manage the functional outcome of acetabular fractures. Settings and Design: The prospective study involves 28 patients of a tertiary care hospital at Bhubaneswar, for analysis of functional and radiological outcomes of surgical management of acetabular fractures. Subjects and Methods: Patients are chosen from emergency and outpatient on the criteria of age group 18–65 years, pelvi-acetabular fractures of 2-mm displacement, more than 3-week-old fracture, with or without hip dislocation. Inflammatory arthritis and pathological fractures patients were excluded. Surgery time was 173 min with a minimum of 110 min and a maximum of 240 min. Statistical Analysis Used: All the data were analyzed using SPSS 20 software. Results: Twelve patients had excellent (42%), seven patients had well (25%), seven patients had fair (25%), and two patients had poor (8%) functional outcomes. Two patients had restricted range of movement and pain on walking and had undergone total hip replacement after 1 year. The mean score in the anatomically reduced fracture is 16.4, imperfectly reduced is 14.4, and poorly reduced is 8. The average functional outcome score was 14.2 (range – 5–18). Conclusions: As the articular surface requires smooth congruity, anatomical fixation of fracture fragments is essential for early mobilization and better functional outcomes. Proper preoperative planning, anatomical reduction, adequate fixation, and early mobilization are required to achieve good functional outcomes in acetabular fractures.

Outcomes of the Modified Stoppa Approach in Acetabular Fracture Management: Incidence of Nerve Injuries.

Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits.

A systemic review and meta-analysis of pararectus versus ilioinguinal approach for the management of acetabular fractures.

The complex anatomy of acetabular fracture needs a surgical approach that can achieve anatomical reduction with fewer complications for the fixation of these fractures. Current literature suggests that both Pararectus (PR) approach and Ilioinguinal (IL) approach can be used for the fixation of these fractures safely. However, superiority of the PR approach over the IL approach is not established. Hence, this meta-analysis aimed to compare the PR versus IL approach. A literature search was performed on five databases Medline/PubMed, Scopus Embase, Cinhal, and Cochrane Library, from the inception to January 14, 2023. A qualitative and quantitative analysis was done for the five eligible studies from the literature search. Individual study characteristics data and outcomes were extracted, and Software version 5.4.1 of Review Manager was used for statistical analysis. Five articles, one Randomized trial (RCT), and four retrospective articles were included and analyzed in this meta-analysis. PR approach has a shorter surgical time [mean difference (MD) -48.4 with 95% CI -74.49, -22.30; p = 0.0003], less intraoperative blood loss (MD -123.22 with 95% CI -212.28, -34.15; p = 0.007), and smaller surgical incision (MD -9.87 with 95% CI -15.21, -4.52; p = 0.0003) than the IL approach. However, the meta-analysis failed to show a difference between the two surgical approaches concerning the quality of reduction, overall complications, nerve injury, vascular injury, heterotopic ossification, deep vein thrombosis, and pulmonary embolism. The PR approach has a shorter surgical duration, less blood loss, and a smaller surgical incision than the IL approach. However, both surgical approaches have equivocal results regarding fracture reduction quality, complication rates, and functional outcomes for acetabular fracture fixation. Hence, for acetabular fractures fixation, PR approach can be considered a safe and feasible alternative to the IL approach.

Rising incidence of acute total hip arthroplasty for primary and adjunctive treatment of acetabular fracture in older and middle-aged adults.

Acute total hip arthroplasty (THA) may be an alternative or an adjuvant to internal fixation for surgical treatment of acetabular fractures. We investigate recent trends in the operative management of acetabular fractures. We hypothesize that the incidence of acute THA for acetabular fractures has increased over time. 4569 middle-aged (45-64years) and older adults (≥ 65years) who received acute operative management of an acetabular fracture within 3weeks of admission between 2010 and 2020 were identified from the United States Nationwide Inpatient Sample database. Treatment was classified as open reduction internal fixation (ORIF), THA, or combined ORIF and THA (ORIF + THA). Patients were stratified by age ≥ 65years old. Associations between demographic factors and the incidence of each procedure over the study period were modeled using linear regression. The relative incidence of treatments was 80.9% ORIF, 12.1% THA, and 7.0% ORIF + THA. Among patients aged 45-64years old, THA increased 4.8% [R2 = 0.62; β1 = 0.6% (95% Confidence Interval (CI) 0.2-0.9%)] and ORIF + THA increased 2.6% [R2 = 0.73; β1 = 0.3% (95% CI 0.2-0.4%)], while the use of ORIF decreased 7.4% [R2 = 0.75; β1 = -0.9% (95% CI -1.2 to -0.5%)]. Among patients ≥ 65years old, THA increased 16.5% [R2 = 0.87; β1 = 1.7% (95% CI 1.2-2.2%)] and ORIF + THA increased 5.0% [R2 = 0.38, β1 = 0.6% (95% CI 0.0-1.3%)], while ORIF decreased 21.5% [R2 = 0.75; β1 = -2.4% (95% CI -3.45 to -1.3%)]. The treatment of acetabular fractures with acute THA has increased in the last decade, particularly among older adults.

OUTCOMES OF TOTAL HIP ARTHROPLASTY FOLLOWING ACETABULAR FRACTURE: IS THERE A DIFFERENCE BETWEEN TOTAL HIP ARTHROPLASTY IN THE ACUTE OR DELAYED SETTING?

Surgical management of acetabular fractures in older patients remains controversial. The purpose of this study is to compare outcomes of primary THA with outcomes after THA for acute acetabular fractures (aTHA) as well as outcomes following delayed THA (dTHA) following prior acetabular fracture.We analyzed data from a large, national administrative claims database containing diagnostic, procedural, and demographic records from over 157 million patients. We identified all patients undergoing primary total hip arthroplasty THA continuously enrolled in the database at least 2 years prior and after the index procedure. Patients with an initial diagnostic code for acetabular fracture occurring the same day as the THA were classified as acute acetabular fractures. Patients with an initial acetabular fracture diagnostic code occurring at least 6 months before THA were classified as chronic acetabular fractures. The comparator group was patients undergoing THA with no history of acetabular fracture. There were 426,734 patients undergoing primary THA, 235 patients undergoing aTHA and 1,255 patients undergoing dTHA.Patients with an aTHA had higher complication rates, including revisions (9.8% vs 5.6%,), dislocations (8.9% vs 6.4%), and periprosthetic fracture (5.1% vs 2.3%) compared to dTHA. After adjusting for age, sex, region, and comorbidities, receiving an aTHA increased the odds of revision (OR = 3.65 [95% CI: 2.30–5.49]), dislocation (OR = 4.09 [95% CI: 2.53–6.27]), and periprosthetic fracture (OR = 4.29 [95% CI: 2.26–7.36]) compared to primary THA. Receiving a dTHA significantly increased the odds of revision (adjusted OR = 1.80 [95% CI: 1.40–2.27]), dislocation (adjusted OR = 2.50 [95% CI: 1.97–3.13]), and periprosthetic fracture (adjusted OR = 1.99 [95% CI: 1.34–2.83]) compared to primary THA.Patients undergoing aTHA in the treatment of an acetabular fracture have significantly increased rates of revision, periprosthetic fracture, and dislocation compared to dTHA and primary THA.

DO-IT-YOURSELF 3D PRINTING FOR ACETABULAR FRACTURE SURGERY: THE WORKFLOW TEMPLATE

3D printing techniques have attracted a lot of curiosity in various surgical specialties and the applications of the 3D technology have been explored in many ways including fracture models for education, customized jigs, custom implants, prosthetics etc. Often the 3D printing technology remains underutilized in potential areas due to costs and technological expertise being the perceived barriers.We have applied 3D printing technology for acetabular fracture surgeries with in-house, surgeon made models of mirrored contralateral unaffected acetabulum based on the patients’ trauma CT Scans in 9 patients. The CT Scans are processed to the print with all free-ware modeling software and relatively inexpensive printer by the surgeon and the resulting model is used as a ‘reduced fracture template’ for pre-contouring the standard pelvic reconstruction plates. This allows use of the standard surgical implants, saves time on intra-operative plate contouring, and also aids in reduction to an extent.We share through this presentation the workflow of the freeware softwares to use in order to use this surgical planning and implant preparation that may remove the perceived barriers of cost and technology from surgeons that wish to explore using 3D printing technology for acetabular fracture management and may extend applications to other regions.

The Outcome of Bicolumnar Acetabular Fracture Treated by Single Anterior Ilioinguinal Approach

Background: Acetabular fracture therapy, being complicated, is generally treated by non-operative methods due to a lack of surgeons’ expertise in pelvis surgery. The surgical exposure and reduction of acetabular fractures may become more direct and practical with the altered technique since it is closer to the acetabular quadrilateral plate. This study aimed to determine the efficacy of a single anterior illio-inguinal approach for the management of a Bi-columnar acetabulum fracture. Methods: Sixty patients, fulfilling the selection criteria were selected for descriptive case series from Orthopedic Surgery Department at Lahore General Hospital, from 02-12-2020 to 02-06-2021. After informed consent, surgery was performed on all patients under general anesthesia. Patients were followed-up and evaluated for efficacy in OPD after 12 weeks of surgery with a Harris hip score. All demographic and other information was recorded on a Proforma. SPSS 22 was used to assess data. Post-stratification, efficacy was compared by using chi-square, p-value ≤0.05 was considered significant. Results: Out of 60 patients, 45(75 %) were male, whereas 15(25%) were female (Mean age 52.71±10.50yrs). The Mean of duration fracture (in days) and Harris score are 11.03±5.29 and 2.83±0.45 respectively. The efficacy concerning lateral side was 60% for left side and 26.7% for right side. Efficacy was higher in less than 10 days old fractures at 55.0% while after 10 days it was 31.7%. We found that the percentage of efficacy was 86.7%. Conclusion: The current study concluded that the anterior illio-inguinal approach is highly effective (p=0.001) in the management of acetabular fractures. Keywords: Acetabulum; Pelvic; Fracture; General Surgery.

Total hip arthroplasty for posttraumatic osteoarthritis secondary to acetabular fracture: An evidence based on 1,284 patients from 1970 to 2018

Posttraumatic osteoarthritis (PTOA) can be a crippling sequela of acetabular fracture (AF), and total hip arthroplasty (THA) is often necessary to alleviate the clinical progression of symptoms. The purpose of this study was to summarize the existing clinical evidence concerning the surgical management of AF with THA through meta-analyses. Databases were searched for articles published between 1995 and January 2022 that contained the keywords "acetabular," "fracture," "arthroplasty," and "osteoarthritis." Our study was registered in PROSPERO under number CRD42022314997. We screened 3,125 studies and included data from 31 studies with 1,284 patients. The median patient age at the time of THA was 52 years and ranged from 19 to 94 years. The pooled overall survival rate was 88% [86%-90%, 95% confidence interval (CI)] and could reach 83% at ≥15-year follow-up. For the Harris Hip Score, we pooled 22 studies with an overall mean difference of 43.25 (40.40-46.10, 95% CI; P < 0.001), indicating a large clinical effect. The pooled complications (incidence rates) across studies were: heterotopic ossification (22.53%), implant dislocation (4.66%), implant infection (3.44%), and iatrogenic nerve injury (1.07%). THA in patients with PTOA following AF leads to significant improvement in symptoms and function at ≥15-year follow-up. Survival rates of implants free from re-operation or revision after THA decreased with follow-up time and could still reach 83% at ≥15-year follow-up. THA might be an effective therapeutic method for patients with PTOA due to AF.

Operative management of acetabular fractures in the elderly: a case series

BackgroundOur objective was to identify acetabular fractures in the elderly population (over 60 years of age), treated with open reduction and internal fixation (ORIF), and to examine their outcomes, primarily the risk for need for further surgery in the form of a total hip arthroplasty (THA), and factors associated with it. Additional outcomes such as infection, avascular necrosis (AVN) of the femoral head, and heterotopic ossification (HO) were also investigated.MethodsFollowing institutional review board (IRB) approval, a retrospective analysis of all consecutive patients presenting to a Level I Trauma Centre over a 13-years period (January 2003–February 2016) was conducted. Patients were excluded if their initial treatment was conservative or simultaneous ORIF with THA.ResultsA total of 62 patients with an age of 71.5 ± 8.04 years were included (14 female; follow-up 54.2 months, range 1–195 months). Sixteen patients required a THA as a secondary procedure due to symptomatic post-traumatic arthritis (25.8%), five (8.1%) of whom having a THA within a year from the original trauma (three patients presenting with loss of reduction and two patients with early AVN). No associations with progression to THA were identified. Surgical approach (ilioinguinal) was the only factor associated with increased risk of development of HO (p = 0.010). The median post-operative survival following an acetabular fracture treated with ORIF was calculated at 90.1 months (95% CI 72.9–107.2).ConclusionAcetabular fractures ORIF in the elderly, is a safe and reliable option. The relatively incidence of development of severe post-operative arthritis was 45.2%. Conversion to THA was 25.8%, with 8.1% having the arthroplasty procedure within a year of the original trauma surgery.Level of evidenceIII.

A Comparison of Acetabular Fracture management by the ilioinguinal or the Modified Stoppa approaches

A Comparison of Acetabular Fracture management by the ilioinguinal or the Modified Stoppa approaches

The Effect of Surgeon Experience on Short- to Medium-Term Complication Rate Following Operative Fixation of Acetabular Fractures

Operative management of acetabular fractures is technically challenging, but there is little data regarding how surgeon experience affects outcomes. Previous efforts have focused only on reduction quality in a single surgeon series. We hypothesized that increasing surgeon experience would be associated with improved acetabular surgical outcomes in general. Retrospective cohort study. Urban academic level-I trauma center. Seven hundred ninety-five patients who underwent an open reduction internal fixation for an acetabular fracture. There was a significant association between surgeon experience and certain outcomes, specifically reoperation rate (16.9% overall), readmission rate (13.9% overall), and reduction quality. Deep infection rate (9.7% overall) and secondary displacement rate (3.7% overall) were not found to have a significant association with surgeon experience. For reoperation rate, the time until 50% peak performance was 2.4 years in practice. Surgeon experience had a significant association with reoperation rate, quality of reduction, and readmission rate after open reduction internal fixation of acetabular fractures. Other patient outcomes were not found to be associated with surgeon experience. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A Rare Case : Traumatic Posterior Hip Dislocation Associated with Anterior Column and Incomplete Posterior Column Acetabular Fracture

Introduction: The hip is among the most solid joints within the human body that took a lot of force to dislocate it. Hip dislocation is frequently associated with acetabulum fracture. Although traumatic posterior hip dislocation is rarely involved anterior column fracture. Case Presentation: We describe a rare case of traumatic posterior dislocation of hip associated with anterior column and incomplete posterior column acetabular fracture in a young female following road traffic accident. The patient hip dislocation was reduced with closed reduction and perfomed open reduction and fixation under C-Arm for acetabular fracture management. Assessment of anterior and posterior acetabular column was revealed stable after fixation. The goals are to maximize the patient's ability to function, enable early recovery to function. The patient was able to flex her left hip at 6 weeks after the surgery. Conclusion: This case highlights a rare case of the traumatic posterior hip dislocation associated with anterior column and incomplete posterior column acetabular fracture, attempts to elucidate the mechanism of injury and perform prompt reduction to achieve a better patient outcome.

Patient-Reported Outcome Measures for Acetabular Fractures Treated Operatively without a C-Arm in Ethiopia.

There is little evidence describing the open treatment of displaced acetabular fractures in low-resource environments. We endeavored to determine the results of the operative management of acetabular fractures without intraoperative C-arm use in a developing nation, through the assessment of patient-reported outcome measures. This was a prospective, single-surgeon, consecutive case series conducted in a tertiary referral hospital in Ethiopia, a high-population, low-income country. The primary author performed fixation without the use of a C-arm in 108 patients from among a total of 202 patients presenting with acetabular fracture. The modified Harris hip score (mHHS) and Short-Form Health Survey (SF)-36 at a minimum of 2 years postoperatively were used to assess the outcome. Of the 108 patients potentially available for analysis, 92 (85%) were available for 2-year follow-up (mean age of 35 years; range, 15 to 70 years). The mean duration from injury to surgery was 16 days (range, 1 to 204 days). Seventy-three (78.5%; n = 93) of the patients had associated fracture patterns. The most common fractures were associated both-column type (22%) and transverse-plus-posterior-wall type (22%). The mean mHHS was 91; 88% of the patients had a score of ≥80, and 12% had a score of ≤79. SF-36 scores were in alignment with the mHHS. The majority (approximately 90%) of our cohort returned to work. We did not find a significant difference in the mean mHHS between patients with or without anatomic reduction (p = 0.31). However, 2-year radiographic outcomes were strongly associated with the mean mHHS (p < 0.001). Predictors of a lower mHHS included older age, cartilage damage, and lack of secondary congruence. Good functional outcomes were achieved at 2 years among patients with acetabular fractures surgically treated without the use of a C-arm in a limited-resource setting. Surgical congruence of the femoral head under the acetabular roof, rather than the absolute residual gap, seems essential in determining clinical outcomes. This information can help in planning increased access to care for individuals who experience traumatic injuries in low- and middle-income countries. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Clinical Outcomes of the Modified Stoppa Combined with Iliac Fossa Approach for Complex Acetabular Fractures: A Medium- and Long-term Retrospective Study.

ObjectiveThe modified Stoppa combined with iliac fossa approach has gained increasing popularity. Although early clinical outcomes have been satisfactory, extensive long‐term clinical outcomes are relatively scarce. The purpose of this study was to evaluate the medium‐ and long‐term outcomes of this approach for complex acetabular fractures.MethodsThis was a retrospective study involving 57 patients with complex acetabular fractures from January 2009 to January 2016. All fractures were treated with the modified Stoppa combined with iliac fossa approach. Follow‐up was at least 5 years. Primary outcome measures, including quality of reduction and clinical outcomes, were recorded by an independent observer. Secondary outcome measures included time to surgery, surgical time, intraoperative blood loss, and perioperative complications.ResultsFifty‐seven patients (range, 18–80 years) included 46 males and 11 females. There were 32 cases on the left side and 25 cases on the right side. The most common associated injury was pulmonary contusion. According to the Judet–Letournel classification, there were 27 both‐column fractures, 16 anterior column with posterior hemitransverse fractures and 14 T‐type fractures. The average time from injury to surgery was 7.3 days. The average intraoperative blood loss and transfusion were 750.9 ml and 564.3 ml, respectively. All fractures healed within 6 months after surgery. The average follow‐up time was 7.7 years, and there was no loss of follow‐up. The quality of reduction was graded as anatomical in 23 cases (40.4%), imperfect in 22 cases (38.6%), and poor in 12 cases (21.0%). According to grading system of Merle d’ Aubigne and Postel, clinical outcomes at 1 year follow‐up were excellent in 17 cases (29.8%), good in 25 cases (43.9%), fair in four cases (7.0%), and poor in 11 cases (19.3%). The excellent and good rate was 73.7% and the difference was not statistically significant compared with the clinical outcomes at the last follow‐up. Intraoperative complications included four cases of obturator nerve injury and two cases of vascular injury. Postoperative complications included one case of wound delayed healing, two cases of deep vein thrombosis, two cases of avascular necrosis of femoral head, three cases of heterotopic ossification and five cases of post‐traumatic arthritis. Only one of these patients underwent reoperation for femoral head necrosis.ConclusionsThe modified Stoppa combined with iliac fossa approach can achieve satisfactory reduction quality and hip function. It might be a valuable alternative to the ilioinguinal approach for the surgical management of acetabular fractures.

Systemic Complications of Obesity in Operative Acetabular Fractures.

To determine the effect of obesity on rates of systemic complications in operatively treated acetabular fractures. Retrospective Case-Control study. Level 1 Trauma Center. All patients with acetabular fractures managed operatively from January 2015 to December 2019. Patients were divided into groups based on their body mass index (BMI) (normal weight = BMI <25 kg/m2, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese = BMI >40). Operative management of an acetabular fracture. Systemic complications, including mortality, sepsis, pneumonia, acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, or venous thrombotic event. A total of 428 patients were identified. One hundred nine patients (25.4%) were in normal weight, 133 (31.1%) were overweight, 133 (31.1%) were obese, and 53 (12.4%) were morbidly obese. The rate of systemic complications was 17.5%, and overall mortality rate was 0.005%. There were no significant differences between the different BMI groups in all-cause complications or any individual complications. When the morbidly obese group was compared with all other patients, there were also no significant differences in all-cause complications or any individual complications. In conclusion, in this study, there was no association with increasing BMI and inpatient systemic complications after operative management of acetabular fractures. As we continue to refine our understanding of how obesity affects outcomes after acetabular fracture surgery, other indices of obesity might prove more useful in predicting complications. In the obese population, there are well-documented risks of postoperative infections and challenges in obtaining an anatomic reduction, but the fear of postoperative systemic complications should not deter surgeons from undertaking operative management of acetabular fractures in the obese population. Because the prevalence of obesity in trauma patients continues to increase, it is incumbent on us to continue to improve our understanding of optimal treatment for our patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Surgical Versus Nonsurgical Management of Acetabular Fractures With Associated Patterns in Elderly Patients: Factors Affecting Outcomes.

Introduction:Among elderly patients, anterior column posterior hemitransverse (ACPHT) and associated both column (ABC) are common acetabular fracture patterns after low-energy mechanisms. Given the paucity of outcomes data in this cohort, the goal of this study was to determine the favorability of results with surgical versus nonsurgical management. Secondarily, factors linked with poor functional outcomes were assessed.Methods:Over a 16-year period, 81 patients aged ≥60 years with 82 ACPHT and ABC acetabular fractures were evaluated. Retrospectively, patient demographics, injury details, and early and late complications were collected. Functional outcomes were assessed with the Musculoskeletal Function Assessment (MFA) after a minimum of 12 months of follow-up.Results:During the study period, 81 patients sustained 82 ACPHT (n = 35, 43%) or ABC (n = 47) fractures, most secondary to low-energy falls (71%). Patients managed surgically were younger, had higher-energy mechanisms, and more often had an associated hip dislocation or marginal impaction (all P < 0.05). Of note, 42.3% and 18.5% of patients had early and late complications, respectively, with no differences between surgical and nonsurgical groups. Posttraumatic arthrosis (PTA) was noted in 27% overall (36% surgical versus 16% nonsurgical, P = 0.10). The mean MFA score was 25.2 after 59 months. Better outcomes were associated with high-energy mechanisms, multiple injuries, and surgical management (all P < 0.05). The worst MFA outcomes were among patients with PTA (40.2) and those requiring a secondary procedure (45.7), both P < 0.05.Discussion:Nonsurgical management had a low rate of PTA. Mitigating PTA and decreasing the rate of secondary surgeries seem crucial achieving satisfactory outcomes. Higher-energy injuries benefit from open reduction and internal fixation, as indicated by better MFA scores.

Advantages of three-dimensional printing in the management of acetabular fracture fixed by the Kocher-Langenbeck approach: randomised controlled trial.

To compare the outcomes of the Kocher-Langenbeck reduction and fixation of the posterior structures of the acetabulum between 3D printing technique and conventional technique. Forty-three patients who sustained fractures of the posterior part of the acetabulum were randomly assigned to two groups: 3D printing (G1; n = 20) and conventional technique (G2; n = 23). The surgical time, intra-operative blood loss, differences between pre-and post-operative haemoglobin, universal functional and radiographic scores, and complications were compared between the groups. The minimum follow-up was 18months. The average operating time (120.75min) and intra-operative blood loss (244ml) were lower in G1 than in G2 (125.87min and 268.7ml, respectively; p = 0.42, p = 0.1, respectively). The difference between the pre- and post-operative haemoglobin was 1.71g/dl in G1 and 1.93g/dl in G2 (p = 0.113). Post-operative complications occurred more frequently in patients in G2 (34.7%) than in patients in G1 (15%), though these differences were also not significant (p = 0.6). The radiographic result was satisfactory in 16 patients (80%) in G1 and 18 patients (78.26%) in G2 (p = 0.5). The clinical result was satisfactory in 15 patients (75%) in G1 and in 17 patients (73.9%) in G2 (p = 0.6). No significant differences were found in terms of surgical time, overall complications, and radiographic or functional outcomes between 3D printing and the conventional technique.