Factors influencing functional outcomes following open reduction internal fixation of acetabular fractures

Joseph, Noah M; Flanagan, Christopher D.; Heimke, Isabella M; Cho, Elizabeth; Pothireddy, Sahini; Scarcella, Nicholas; Vallier, Heather A.

doi:10.1016/j.injury.2020.11.027

Cited by 9 publications

(14 citation statements)

References 48 publications

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“…Ethnicity was not found to be a risk factor in 1 study 19 . Male sex was identified as a risk factor for HO in only 1 of 10 studies (reported p < 0.01) 7,13,19,28,30-32,35,37,39 . Similarly, increased age was reported as a risk factor in 2 of 10 studies (reported p = 0.03, reported p = 0.007) 7,19,28,30,32,36,37,39,40,45 .…”

Section: Resultsmentioning

confidence: 99%

“…Neurological injuries: Head or spinal cord injury and traumatic brain injury (TBI) were assessed as risk factors in 7 studies 7,13,31,32,37,39,40 , but only 1 identified a significant association (TBI: reported p = 0.014 [OR: 8.6, 95% CI: 1.7 to 43.8]) (Table II) 7 .…”

Section: Resultsmentioning

confidence: 99%

“…Surgical approach: Thirteen studies assessed the effects of the surgical approach on the development of HO 7,8,27,28,30,31,34-36,40,41,44,45 , with 9 reporting significant associations (Table II) 27,30,34-36,40,41,44,45 . The extended iliofemoral approach was reported to have the highest risk (reported p = 0.0002 [OR: 4.4, 95% CI: 2.0 to 9.4] versus the Kocher-Langenbeck and ilioinguinal approaches, and reported p = 0.011 versus the triradiate approach) 41,44 .…”

Section: Resultsmentioning

confidence: 99%

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Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures

et al. 2022

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Background:Heterotopic ossification (HO) following acetabular fractures is a common complication that may affect clinical outcomes. However, the effects of prophylactic treatment with nonsteroidal anti-inflammatory drugs or radiation therapy remain controversial. While several factors have been related to the development of HO, there is considerable uncertainty regarding their importance or effect size in the setting of acetabular surgery. Therefore, this systematic review aims to summarize the risk factors for HO following the operative fixation of acetabular fractures and clarify their interrelationships.Methods:In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, MEDLINE, Embase, and CINAHL databases were searched from inception to February 2021. Studies that assessed factors related to HO development among patients with operatively repaired acetabular fractures were included. Outcomes were risk factors and their effect size (p values, odds ratios, and 95% confidence intervals).Results:Twenty-five studies and 1 conference abstract with a total of 3,940 patients were included. The following risk factors for HO were identified. Patient factors were increased body mass index, male sex, and increased age. Injury factors were intensive care unit (ICU) admission and length of stay, non-ICU hospitalization for >10 days, the need for mechanical ventilation for ≥2 days, abdominal and/or chest injuries, the number and type of associated fractures, traumatic brain injuries, T-type acetabular fractures, pelvic ring injuries, and hip dislocation. Care factors were a delay to surgery, extensile and posterior surgical approaches to the hip, trochanteric osteotomy, postoperative step-off of >3 mm, and a delay to prophylaxis following injury or surgery. Ethnicity, Injury Severity Score, cause of the fracture, femoral head injuries, degloving injuries, comminution, intra-articular debris, the type of bone void filler, gluteus minimus muscle preservation, prolonged operative time, and intraoperative patient position were not risk factors for developing HO.Conclusions:HO following operative fixation of acetabular fractures is not uncommon, with severe-grade HO associated with substantial disability. Careful consideration of the risk factor effect sizes and interdependencies could aid physicians in identifying patients at risk for developing HO and guide their prophylactic management. The results of this study could establish a framework for future studies.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures

et al. 2022

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“…In some long‐term follow‐up studies, traumatic arthritis was the most common complication with an incidence of 20% 2 , 16 . Especially, the quality of reduction is the only independent risk factor to evaluate the prognostic outcome 17 , 18 , 19 , 20 . Therefore, in the treatment of this type of fracture, it is necessary to ensure anatomic reduction of the fractures as much as possible.…”

Section: Discussionmentioning

confidence: 99%

Both‐Column Acetabular Fractures: Should Pelvic Ring Reduction or Acetabulum be Performed First?

Wan

et al. 2022

Orthopaedic Surgery

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Objective Both‐column acetabular fracture is a type that accumulates both the pelvis and acetabulum with complex fracture line alignment and has variant fracture fragments. The selection of different reduction landmarks and sequences produces different qualities of reduction. This study aims to compare the operation‐related items, quality of reduction, and hip functional outcome by using different reduction landmarks and sequences for management of both‐column acetabular fractures (BCAF). Methods A consecutive cohort of 42 patients from January 2013 to January 2019 with BCAF were treated operatively with different reduction landmarks and sequences: pelvic ring fractures reduction first (PRFRF group) and acetabular fractures reduction first (AFRF group). Preoperative computer visual surgical procedures were applied. There were 22 patients in PRFRF group and 20 patients in AFRF group. The surgical details, complications, radiographic and clinical results were recorded. The quality of reduction was assessed by the Matta scoring system. The functional outcome was evaluated by the modified Merle d'Aubigné and Postel scoring system. The measurement data were analyzed using the t‐test of independent samples and rank‐sum test of ranked data. Results The real reduction sequence in both groups was almost identical to the preoperative surgical procedures. The excellent/good quality of reduction in PRFRF group (21/22) was better than AFRF group (17/20). Operative time (152.3 ± 16.3 mins) and intra‐operative blood loss (639.5 ± 109.9ml) were significantly reduced in PRFRF group (p < 0.05). The incidence of deep vein thrombosis in PRFRF group (2/22) was less than AFRF group (4/20), but without statistical signification. Conclusion Selection of an appropriate reduction landmark and sequence could result in better quality of reduction, operative time, and decreased blood loss during treatment of BCAF.

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“…While classes I and II HO are typically asymptomatic, classes III and IV are considered severe forms of HO. These severe forms have been shown to result in worse hip function, as measured by Harris Hip Scores9 and Musculoskeletal Function Assessment questionnaires 10. In rare cases, patients with severe HO require surgical excision of the ectopic bone to improve function 11.…”

Section: Introductionmentioning

confidence: 99%

Heterotopic ossification prophylaxis after acetabular fracture fixation using a posterior approach: a retrospective study at a level 1 trauma center

Kitchen

Hartley

Seligson

2022

Current Orthopaedic Practice

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Background:Heterotopic ossification (HO) is a known complication of acetabular fracture repair. After surgery, standard methods for HO prevention involve observation, radiation therapy, or a course of nonsteroidal antiinflammatories (indomethacin). Methods:A retrospective chart review was performed to analyze the effectiveness of radiation and indomethacin as HO prophylaxis after acetabular fracture surgical repair. Data were analyzed from 117 patients who underwent stabilization of the acetabulum utilizing a posterior approach from 2016 to 2020. Patients were classified into three groups based on the postoperative therapy received: radiation therapy, indomethacin therapy, or no prophylaxis. Grade of HO for each patient was determined by examining pelvic radiographs using the Brooker classification system at the most recent follow-up. Incidence of total and severe HO was recorded for each group and compared. Demographics, follow-up time, injury severity, and other trauma characteristics also were reported. Statistics were calculated using a combination of analysis of the variance (ANOVA), chi square, and Kruskal-Wallis testing. Results:The indomethacin group was younger than the other two groups with a shorter average follow-up time. The radiation group demonstrated a lower incidence of severe and total HO compared to the control group. The indomethacin group had significantly less total HO than the control group. Conclusions:With a decreased incidence of severe HO in the radiation group compared to no prophylaxis, this study supports the utility of radiation therapy as HO prophylaxis following acetabular fracture repair using a posterior approach. It shows a trend indicating that indomethacin also may be useful.

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Factors influencing functional outcomes following open reduction internal fixation of acetabular fractures

Cited by 9 publications

References 48 publications

Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures

Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures

Both‐Column Acetabular Fractures: Should Pelvic Ring Reduction or Acetabulum be Performed First?

Heterotopic ossification prophylaxis after acetabular fracture fixation using a posterior approach: a retrospective study at a level 1 trauma center

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