Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures

Sreevathsa Boraiah, Mary Ragsdale, Timothy Achor, Steven Zelicof, David E Asprinio
Journal of Orthopaedic Trauma 2009, 23 (4): 243-8

OBJECTIVE: The purpose of our study was to analyze the outcomes of patients treated with combined open reduction internal fixation (ORIF) and primary total hip arthroplasty (THA) for selected cases of acetabular fractures.

DESIGN: Retrospective case series.

SETTING: University Medical Center.

PATIENTS AND PARTICIPANTS: Four hundred twenty patients underwent ORIF for displaced acetabular fractures at our institution. Twenty-one of these patients underwent ORIF and primary THA. All surgeries were performed under the direct supervision of a fellowship-trained orthopaedic trauma surgeon and a fellowship trained adult reconstructive surgeon who acted as a cosurgeon. At the time of review, 18 patients met the 1-year follow-up requirement and formed the study cohort. Mean patient age was 71 years (range 55-86 years). There was 1 transverse fracture, 1 anterior column posterior hemitransverse and 1 both-column fracture. There were 15 posterior wall fractures. Of the 15 posterior wall fractures, 1 was associated with posterior column fracture, 1 with dome fracture, 2 with transverse fractures, and 9 with femoral head impaction fracture. There were 2 patients with isolated posterior wall fractures. Clinical outcomes were analyzed using Harris hip score. Radiographs were analyzed for implant migration and loosening around the implant.

RESULTS: Of the 18 patients in the study, 14 patients were followed for more than 2 years (average 3.9 years, range 1-10.1 years). All but 1 patient healed successfully. One patient required revision and placement of a constrained prosthesis due to failure of acetabular component, 3 weeks post-index procedure. Harris hip score ranged from 78 to 99 with a mean of 88. The radiographs showed an average medial displacement of 1.2 mm (range 0-3 mm) and an average vertical displacement of 1.3 mm (range 0-4 mm). There was no radiographic evidence of acetabular component loosening, but loosening was evident on 1 uncemented femoral stem.

CONCLUSIONS: Treatment of acetabular fractures remains challenging particularly in the presence of severe osteopenia, comminution, or associated femoral head fracture. In appropriately selected patients, ORIF and primary THA provide an acceptable treatment option.

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