Immediate outcomes of early versus late definitive fixation of acetabular fractures: A narrative literature review

Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation

“…Recent literature has debunked these precepts. 13,14,20,21 Reduction and fixation within the first 48 hours has actually been associated with lower blood loss and shorter surgical procedures with regard to fractures of the spine or acetabulum. 3,16,20-23,39…”

“…7,11,14 Application of these principles has advanced beyond femoral shaft fractures to include fractures of the thoracolumbar spine, pelvis ring, acetabulum, and proximal femur, which carry a similar burden for the patient. 4,14,[16][17][18][19][20][21][22][23] More recent literature supports the efficacy of these strategies in reducing complications, hospital stays, and costs. 14,15,[19][20][21] Extending these principles outside of single trauma centres, and sometimes beyond individual orthopaedic trauma surgeons working at a specific centre, entails development of networks of care with detailed algorithms and quality assessment processes.…”

“…4,14,[16][17][18][19][20][21][22][23] More recent literature supports the efficacy of these strategies in reducing complications, hospital stays, and costs. 14,15,[19][20][21] Extending these principles outside of single trauma centres, and sometimes beyond individual orthopaedic trauma surgeons working at a specific centre, entails development of networks of care with detailed algorithms and quality assessment processes. 3,16,18,22,[24][25][26][27] Striving beyond individual provider and institutional borders and interests is imperative to maintaining sustainable systems of care with optimal clinical outcomes.…”

“…13,14,20,21 Reduction and fixation within the first 48 hours has actually been associated with lower blood loss and shorter surgical procedures with regard to fractures of the spine or acetabulum. 3,16,[20][21][22][23]39 Low-energy fractures of the hip, usually occurring in elderly patients, have also been treated expeditiously for the agreedupon benefits of lower pulmonary and thrombotic complications and reduced mortality. 8,25,34,40 Shorter length of hospital stay has also been identified.…”

A Modified Cannulated Cancellous Bone Impactor Is a Helpful Tool During Acetabular Fractures ORIF, a Technical Note

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T he general aim of fracture management is to obtain proper reduction and alignment (axial and rotational), followed by fixation, which should eventually lead to fracture union in an accepted position that helps the patient return to his/her preinjury level of activity and function. 1 These aims could be more challenging when dealing with intra-articular fractures, where fracture reduction should be anatomic to avoid secondary osteoarthritis; this makes acetabular fractures to be one of the most challenging intraarticular fractures to treat owing to their complex anatomy, various injury patterns, and patient-related factors such as obese or muscular patients, which adds to the complexity of the surgery. 2,3 To obtain an anatomic reduction of complex acetabular fractures, a lot of reduction assisting tools and clamps were introduced, such as the ball spike pusher, Farabeuf clamp, pointed reduction forceps, and offset clamps.

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