Long term results after surgical management of posterior wall acetabular fractures

Abstract

BackgroundPosterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome.Materials and methods We retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25–60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5–22 years) who met the inclusion criteria formed the study cohort. Matta’s criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d’Aubigné and Postel score.ResultsAnatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d’Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery.ConclusionAnatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures.Level of evidence(Level 4) Retrospective case series.

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures

“…The authors identified a total of 12 articles (Figure) on posterior wall acetabular fracture that stated the weightbearing protocol and the Merle d'Aubigné functional scores (Table 1). 4,[11][12][13][14][15][16][17][18][19][20][21] A review of the included articles revealed that the typical postoperative weight-bearing protocol for posterior wall acetabular fractures involves a progressive but limited weight-bearing schedule for the first 12 weeks, followed by full weight bearing thereafter. Table 1 is organized from most liberal weight-bearing schedule to most conservative.…”

Tratamiento quirúrgico de las fractura de pared posterior de acetábulo. Resultados a corto y mediano plazo

“…Magu y col. 16 refieren que pacientes con fracturas asociadas en extremidades inferiores presentan peores resultados. De nuestra serie, el 25% de los pacientes presentaron fracturas asociadas.…”

“…De estos pacientes todos presentaron una fractura conminuta y un 80% impactación marginal. Magu y col. 16 en su serie retrospectiva de 25 pacientes, reportan un 12% de ATC después de cirugía de pared posterior de acétabulo a los 12 años de seguimiento. Pascarella y col. 21 reportan en su serie de 121 pacientes un 16,5% de ATC al final del seguimiento que fue en promedio a los 53 meses.…”

Retrospective Analysis of Traumatic Triradiate Cartilage Injury in Children

“…Both surgical treatment and conservative treatment have been reported. For unstable pelvic fractures and acetabular fractures, regardless of whether it is combined with TCI, active ORIF is recommended, which is very helpful to restore the anatomical structure of the pelvis and reduce complications [18,19]. Most patients in the previous literature have received conservative treatment, includes bed rest and skeletal traction for 4 to 8 weeks [7].…”