Background.
Acetabular fractures, a rising concern in developing countries, pose a significant challenge due to their complexity and association with post-operative complications. Often caused by high-energy mechanisms like falls and motor vehicle accidents, these fractures require accurate reduction to prevent long-term issues and potential need for hip replacement. This study investigates the radiological outcomes of acetabular fracture surgery at six months, focusing on the effectiveness of achieving anatomical reduction using the Matta criteria in a low- and middle-income country (LMIC) setting.
Methods and material.
This prospective study was conducted at a tertiary care center in Pakistan from May 2023 to December 2023, with ethical approval. Patients with isolated acetabular fractures were recruited. Preoperative X-rays and CT scans classified fractures using the Judet and Letournel Classification. Six-month postoperative X-rays were assessed using Matta radiographic criteria. Appropriate statistical analysis was deployed with a significance level set at p < 0. 05.
Results
A total of 33 cases met the study criteria, with an average patient age of 43.2 years. Males constituted 87.9% of the cases. Longer hospital stays were associated with poorer outcomes (p < 0.001). Fracture patterns were significant predictors of outcomes (p < 0.001). Six months post-surgery, 45.5% of patients had excellent results, 24.2% had good results, and 15.2% each had fair and poor results according to the Matta radiographic criteria. Avascular necrosis (AVN) developed in 9.1% of patients. Of the ten patients with femoral head dislocation, only one developed AVN
Conclusion.
This LMIC-based study investigated factors affecting outcomes in patients with acetabular fractures treated using ORIF. We found a younger patient population compared to high-income countries, and injury patterns suggested a link to the local environment (e.g., traffic accidents). Optimizing hospital stay and timely surgery improved radiological outcomes as assessed by Matta criteria. While limitations exist, the study supports using Matta criteria in LMICs. Future research with larger, multicenter designs incorporating function is needed. Importantly, our findings highlight the need for a new LMIC-specific classification system considering factors like comminution and femoral head dislocation to improve surgical planning and outcomes.
