Results after operative treatment of transverse acetabular fractures.

BACKGROUND: Treatment of the transverse acetabular fracture is known to have worse results than other fracture types, although this fracture belongs to the elementary fracture group. The operative results of the transverse acetabular fracture, however, have not been well documented. To determine the results and factors that affect the choice of operative treatment for transverse acetabular fractures, we retrospectively reviewed 15 cases of transverse fracture.

METHODS: A total of 15 patients had a transverse fracture, with an average follow-up period of 43 months; there were 8 patients with and 7 without a posterior wall fracture. There were 11 men and 4 women, with a mean age of 46.6 years. In seven cases there was also comminution of the weight-bearing dome. The surgical approaches used were the anterior ilioinguinal approach in 4 patients, the posterior approach in 10 patients, and the combined approach in 1 patient. Postoperative radiographic results were evaluated by Matta's criteria. Final clinical results were evaluated by a modified Merle d'Aubigne scoring system.

RESULTS: All of the fractures healed. The average time for fracture healing was 17.5 weeks. Postoperative radiology revealed six cases of anatomical reduction, five cases of imperfect reduction, and four cases of poor reduction. According to the clinical results, nine patients had satisfactory results (three excellent, six good), and six had unsatisfactory results (three fair, three poor). Regarding complications, there were four cases of traumatic osteoarthritis and three of heterotopic ossification. The patients with an anatomical reduction had a higher satisfactory result rate. Comminution of the transverse fracture seemed to have an adverse influence on the postoperative radiologic result as well as a correlation with the development of traumatic arthritis.

CONCLUSIONS: Transverse acetabular fractures, if not reduced anatomically, may have a tendency toward traumatic osteoarthritis and poor clinical outcome. Comminution of the dome may portend poor results.