Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture |
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| Affiliation: | 1. Department of Orthopaedic and Trauma Surgery, Ospedali Riuniti, Ancona, Italy;2. Section of Orthopaedics and Trauma Surgery, Department of Public Health, “Federico II” University, Naples, Italy;1. Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland;2. Institute for Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland;3. Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Bühlstrasse 20, 3010 Bern, Switzerland;4. Institute of Anatomy, University of Bern, Switzerland;1. Australian Institute of Health Innovation, Macquarie University, Australia;2. Sydney Nursing School, The University of Sydney, Australia;3. St George Hospital, Sydney, Australia;1. Ankara Numune Training and Research Hospital, Orthopaedics and Traumatology Clinics, Ankara, Turkey;2. Ankara Training and Research Hospital, Orthopaedics and Traumatology Clinics, Ankara, Turkey;3. Antalya Training and Research Hospital, Antalya, Turkey;1. Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, United States;2. Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, United States |
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| Abstract: | The purpose of this study was to evaluate the results of open reduction and internal fixation in a large series of posterior wall fractures of the acetabulum and to identify the factors that affect the outcomes in this case series. One hundred twenty-one patients who had undergone open reduction and internal fixation of a fracture of the posterior wall of the acetabulum were assessed at a mean of 53 months (range, 24–163) after surgery. The functional outcome was evaluated with use of the modified Merle d'Aubigne scoring system, the Harris Hip Score (HHS), and the Short Form-36 Health Survey (SF-36) questionnaire. Final follow-up radiographs were graded according to Matta's radiologic criteria. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional and radiographic outcome. The quality of fracture reduction on postoperative radiographs was anatomical in 115 hips (95.0%), satisfactory in 6 cases (5.0%), and unsatisfactory in none. Final modified d'Aubignè scores were excellent in 45 hips (40.2%), good in 52 (46.4%), fair in 7 (6.3%), and poor in 8 (7.1%). Mean HHS was 91.5 ± 8.9 (48–100). The SF-36 scores were similar with respect to age and sex-matched norms, but physical domains in males remained lower in comparison with the normal population. The early reduction of an associated hip dislocation and quality of surgical reduction were strong positive predictors of functional and radiographic outcomes at follow-up, whereas associated injuries and the existence of pre-operative nerve palsy were negative predictors of patients' functionality. This study of surgically treated fractures of the posterior wall of the acetabulum has shown that functional and radiographic results are satisfactory in most patients, provided that prompt reduction of an associated hip dislocation and anatomical reduction of the fracture are carried out. Associated injuries and nerve lesions affect the final functional outcome. |
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| Keywords: | Acetabulum Fracture Posterior wall Surgery Open reduction internal fixation Outcome Prognosis |
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