Two to Twenty-Year Survivorship of the Hip in 810 Patients with Operatively Treated Acetabular Fractures

Abstract

Open reduction and internal fixation of displaced acetabular fractures was able to successfully prevent the need for subsequent total hip arthroplasty within twenty years in 79% of the patients. The results represent benchmark comparative data for any future and past studies on the outcome of surgical fixation of acetabular fractures.

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

“…We evaluated the baseline data in the 2 groups and noted a larger degree of preoperative dislocation of the acetabular roof in the 3D group, and similar distribution between the 2 groups with respect to fracture type, age, and sex. The baseline parameters were comparable to those in the other acetabular fracture studies reported in this manuscript (Briffa et al 2011, Oberst et al 2012, Tannast et al 2012, Shazar et al 2014). Propensity score methods are an option to reduce potential bias between trial arms in non-randomized trials.…”

“…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.…”

“…Of these, 73% were anatomical, 12% were imperfect, and 14% were poor. Tannast et al (2012) operated on 1,326 acetabular fractures and reported on 816 acetabular fractures with radiographic evaluation. Of these, 75% of reductions were anatomic, 18% were imperfect, and 4% were poor.…”

“…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. Most surgeons use computed tomography (CT) of the acetabulum to plan their approach and strategy before fracture surgery.…”

Anteriore Zugänge zum Acetabulum

“…In der Serie von Matta zeigte sich, dass nach 2-20 Jahren in 21% eine Hüfttotalprothe-se nötig wurde [28]. Risikofaktoren für ein schlechtes Resultat sind das Frakturmuster, die superomediale Acetabulumdomimpaktion, das initiale Ausmaß der Frakturdislokation, der Femurkopfschaden, das erhöhte Patientenalter, die verzögerte operative Versorgung und v. a. die Qualität der Reposition [1,2,7,28]. Frakturen mit der Hauptdislokation im vorderen Pfeiler werden über anteriore Zugänge versorgt.…”