Bilateral acetabular fractures: Mechanism, fracture patterns and associated injuries

Abstract

Introduction: Acetabular fractures are uncommon and their management is often reserved for specialist pelvic and acetabular surgeons. Bilateral acetabular fractures are a particularly rare subgroup. We report the incidence, fracture pattern, mechanism of injury and outcome of patients presenting to a tertiary trauma centre with traumatic bilateral acetabular fractures. Method: Bilateral acetabular fractures were identified from a prospective database of acetabular fractures presenting to one institution over a six-year period. Patient notes and imaging studies were reviewed to identify demographics, mechanism of injury, Injury Severity Score, fracture pattern and management. Timing of operative management was explored. Patient outcomes were collected in the form of radiographs and Oxford Hip Scores at a minimum of one-year post injury. Results: Eight patients with bilateral acetabular fracture were identified from a database which contained records of 519 patients with acetabular fractures (incidence of 1.5% amongst patients with acetabular fractures). Motor vehicle accidents were the most common mechanism. Four acetabular fracture patterns were observed within the cohort. Radiographic union occurred in all cases and Oxford Hip Scores are suggestive of moderate to well functioning hip joints. Fractures were treated as single or staged procedures. Conclusion: Bilateral acetabular fractures are very rare due to the unique degree and pattern of force required to fracture both acetabula. They are associated with 4 main fracture patterns and present with Injury Severity Scores that averaged 25 (severe). They are typically observed in young males with road traffic collision being the most common mechanism of injury.

Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

“…Three case reports [4,42,43] were further excluded at this stage, as they did not report relevant outcomes. Thirtysix case reports [35][36][37][38][39][40][41] and 1 short case series [34] were finally included and formed the basis of this review (Table 1).…”

“…Overall, there were 58% excellent/good outcomes with complete functional recovery and independent mobilization [5, 7, 9, 10, 13, 15-18, 22, 25, 26, 28, 31, 33-35, 38-40], 22% fair with limited range of motion of both hips and moderate pain [6,8,23,30,32,34,36,37], and 20% poor outcomes with limited activity and walking ability (Table 7) [11,12,14,20,21,24,34]. According to injury group, excellent/good outcomes were reported in 60% of the high-energy patients [13,15,18,25,26,33,34,38,39], 47% of the seizures patients [9,10,16,17,22,31,35,40], and in 100% of the insufficiency fracture group [5,7,28].…”

“…Those were reported in 89% of the cases (42/47 cases) [5-14, 16, 17, 19-24, 26-34, 36-41]. The most common associated injuries were upper limb injuries (26%) [8,10,13,17,19,31,32,34,37,39], pelvic fractures (23%) [7,11,12,34,36,38,39,41], femoral fractures (19%) [10,16,31,32,34,38], spine injuries (14%) [10,27,30,31,34], acetabular fracture associated with hip dislocation (23%)…”

Clinical and radiological outcome measures in patients after reconstruction of displaced acetabular fractures.

“…5,18 The standard of fixation depends on the size of step or gap. 7,9,11 We established that precise evaluation of steps and gaps was very difficult unless peroperative and so felt defensible using congruency of reduction observed on the radiographs after the surgery as part of evaluation, particularly for those fracture configurations revealed small gaps in particular surface of some anatomical classified reductions. We noted strong association between fixation and its effectiveness.…”

“…4 Components that affect outcome include delay in surgery, the fracture pattern, the patient's age, associated articular cartilage damage of head of femur and acetabulum, dislocation at the time of injury, correlated neurovascular injury and comorbidities of the patient. [5][6][7][8][9][10][11][12] This study was done to determine the clinical and radiological outcome of surgical treatment of acetabular fractures in patients after reconstruction of displaced acetabular fractures. 2014 till December 2019 at the Department of Orthopedics, Lahore General Hospital, Lahore.…”