gms | German Medical Science

Objectives: Unstable acetabular fractures are high-energy injuries usually associated with road accidents. About 2/3 of the patients are young, predominantly male, and associated lesions are very common, ranging from 40 % to 75 %.

The aim of our study was to review the epidemiology, functional and radiological outcome of fractures of the acetabulum treated surgically.

Methods: All unstable fractures of the acetabulum undergoing surgery in the period between January 2006 and December 2013 in our institution were retrospectively analyzed. Anthropometric data, date of accident, fracture pattern and mechanism of injury, type of surgery and surgical approach, associated injuries, hospital days, immediate and late complications (osteoarthritis, AVN, persistent neurological injury, heterotopic ossification, other complications of other fractures), reoperation and mortality were recorded. Matta's criteria were used to grade the postoperative reduction, and functional outcome was assessed according to the grading system developed by Merle d'Aubigné and Postel.

Results and Conclusion: Twenty-nine patients (23 men, six women), with a mean age of 39.4 years (range 13-67 years) and a mean follow-up of 4,2 years (range 1,3-8,3 years), met the inclusion criteria. One patient was followed in another institution, and two patients died, not being assessed at the final follow up. Road accident was the most prevalent mechanism of injury (14 cases, 48,2 %). According to the classification of Letournel and Judet, fractures of the posterior wall were the most frequent, being present in 9 patients (31 %). The second most frequent type were fractures of the two columns, which occurred in 7 patients (24,1%). One patient with transvers fracture of the posterior wall underwent total hip arthroplasty as the primary treatment. Of all patients, 22 (75,8 %) had associated lesions. In 14 patients (53,8%) late complications were recorded. Six patients (23,1%) had clinical imaging correlation of osteoarthritis and one patient (3.8%) imaging evidence of AVN. One patient (3,8%) developed heterotopic calcification and 4 patients (15,4%) sciatic lesions. At the final follow up no patient had undergone hip arthroplasty. The postoperative reduction was graded as anatomical in 21 hips (75%) and poor in 2 patients (7,1%). The functional result was excellent in 9 patients (33,3%), good in 11 patients (40,7%), fair in 5 patiens (18,5%) and poor in 2 patients (7,4%). The clinical result was positively related with anatomical reduction and postoperative congruity between the femoral head and the acetabular dome.

These findings indicate that in many patients, who have a complex acetabular fracture, the hip joint can be preserved and post-traumatic osteoarthritis can be avoided if an anatomical reduction is achieved. An increase in the rate of anatomical reduction and a decrease in the rate of operative complications should be the goals of surgeons who treat these fractures.