Operative treatment of displaced fractures of the acetabulum

Abstract

Over the past 40 years, the management of displaced fractures of the acetabulum has changed from conservative to operative. We have undertaken a meta-analysis to evaluate the classification, the incidence of complications and the functional outcome of patients who had undergone operative treatment of such injuries. We analysed a total of 3670 fractures. The most common long-term complication was osteoarthritis which occurred in approximately 20% of the patients. Other late complications, including heterotopic ossification and avascular necrosis of the femoral head, were present in less than 10%. However, only 8% of patients who were treated surgically needed a further operation, usually a hip arthroplasty, and between 75% and 80% of patients gained an excellent or good result at a mean of five years after injury. Factors influencing the functional outcome included the type of fracture and/or dislocation, damage to the femoral head, associated injuries and co-morbidity which can be considered to be non-controllable, and the timing of the operation, the surgical approach, the quality of reduction and local complications which are all controllable. The treatment of these injuries is challenging. Tertiary referrals need to be undertaken as early as possible, since the timing of surgery is of the utmost importance. It is important, at operation, to obtain the most accurate reduction of the fracture which is possible, with a minimal surgical approach, as both are related to improved outcome.

Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

“…The strong correlation between the quality of articular reduction of the weight-bearing dome and the clinical outcome after 1–2 years (Giannoudis et al 2005, Tannast et al 2012) suggests that the residual steps and gaps that remain undetected with the fluoroscope—but are identifiable with 3D imaging—have clinical relevance and should be corrected.…”

“…Giannoudis et al (2005) found that patients with residual articular steps of the acetabular roof smaller than 2 mm had a 13% risk of coxarthrosis and that patients with articular steps larger than 2 mm had a 43% risk. Tannast et al (2012) reported a 27% conversion rate to arthroplasty after acetabular surgery in 816 patients, with a close correlation to the quality of reduction postoperatively.…”

Quadrilateral plate fractures of the acetabulum: An update

“…[11][12][13][14][15][16][17] These fractures of mainly the elderly population, also pose several specific treatment challenges compared to those of young high-energy trauma patients who are traditionally associated with acetabular fractures. 7,12,13,[18][19][20][21][22][23] Until the 1960s most acetabular fractures were treated nonoperatively. Traction was first recommended by Cottloda in 1922 and represented the mainstay of management.…”

“…It was the pioneering work of Judet and Letournel that resulted in operative treatment becoming the standard of care, as it is today. 4,20,24 The current consensus regarding the contemporary aims of acetabular fracture treatment are to relieve pain, allow early mobilisation, restore function by restoring the normal hip joint anatomy; thereby limiting the risk of early post-traumatic arthritis using the modality that offers the greatest chance of success. 6,7,13,16,25,26 Selection of a specific method of treatment of any acetabular fracture depends on numerous factors including age, functional status, fracture pattern, degree of displacement, associated injuries pre-existing local and general condition as well as the available surgical expertise.…”

“…6,7,13,16,25,26 Selection of a specific method of treatment of any acetabular fracture depends on numerous factors including age, functional status, fracture pattern, degree of displacement, associated injuries pre-existing local and general condition as well as the available surgical expertise. 3,20,27 Current treatment options for acetabular fractures include both conservative and operative methods. Over time, prognostic indicators of outcome have been defined and this has led to an increasing trend towards operative fixation.…”