gms | German Medical Science

Objectives: The treatment of acetabular fractures is generally challenging. Surgical treatment is often complex and comes along with great perioperative risk. Yet, stability and congruity of the hip joint needs to be ensured to achieve early mobilization, painlessness, and a good functional outcome. Therefore, reaching an accurate decision, whether surgical treatment strategy is indicated or not is the key for a successful therapy.

Methods: We retrospectively evaluated data from the German pelvic Trauma Registry (n = 4.213). The cases were reviewed especially regarding the number of performed surgery. Furthermore, a logistic regression model with the dependent variable surgical treatment was established.

Results: 25.8% (4.213/16.359) of the patients suffered from an acetabular fracture. 61.9% (2.606/4.213) of these underwent surgery. Important in indicating a surgical therapy is the fracture classification. While 10.2% of the cases with an anterior wall fracture (38/374) were treated surgically, posterior column and posterior wall fractures were operated on in 90.2% of the cases (110/122) (Figure 1A). Another important decision factor for a surgical therapy was a fracture gap >3mm (1.999/2.367), whereas a fracture gap <1mm was treated non-operatively in the majority of the cases (206/1033) (adj.OR 0.12 [95%CI 0.09-0.15]) (Fig. 1C). Also gender had a significant influence on coming to a decision, too. Women underwent surgery in 51.4% (620/1.206), men in 66.0% (1.986/3.007) (adj.OR 0.79 [95%CI 0.66-0.95]) (Figure 1B). Apart from the ISS (adj.OR 0.97 [95%CI 0.96-0.98]), factors characterizing the total image of the injury were of no importance for indicating a surgical therapy (isolated pelvic fracture: 62.0% (1.316/2.124), polytrauma: 58.8% (583/992); adj. OR 1.06 [95%CI 0.76-1.47]). The reason given most frequently for non-operative treatment was "minimal displacement" (678/1.607).

Conclusion: Besides the fracture classification and factors that characterize the fracture itself, unexpectedly gender has an influence on whether surgery is performed or not. In contrast, except for the ISS, factors characterizing the overall injury are of no importance for the decision. Future studies will need to determine the relevance of these factors and whether they should be part in the decision-making process. In any case, it is however advisable to be aware of the criteria which the decision is based on.