[Operative outcomes of complex acetabular fractures and its influence factors]

Changchao Dong, Gang Wu, Guanglin Wang, Tianfu Yang, Yue Fang, Lei Liu, Jianli Xue
Chinese Journal of Reparative and Reconstructive Surgery 2009, 23 (4): 430-4

OBJECTIVE: To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors.

METHODS: From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accident in 40 cases, falling from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker-Lagenbach approach was used in 23 cases, anterior ilioinguinal approach was applied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases.

RESULTS: Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external iliac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn't collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled'Aubigné-Postel hip score system. Patients' quality of life was compared with local population norms matched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vitality, role limitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, quality of fracture reduction and traumatic arthritis were independent risk factors affecting postoperative functional outcomes.

CONCLUSION: Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, quality of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.

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