COMPLEX ACETABULAR FRACTURES OPERATED VIA AN EXTENDED ILIOFEMORAL APPROACH: RESULTS IN 109 FRACTURES AT TWO YEARS OR MORE

Abstract

Purpose: Diverse extended approaches have been described for the treatment of complex acetabular fractues. Little data is however available concerning the results, morbidity, and complications of acetabular fractures treated with this approach. The purpose of this work was to assess outcome in procedures performed by a single operator using the extended iliofemoral approach as described by Letournel for the treatment of acetabular fractures.

Material and methods: The database of the senior author included 833 acetabular fractures, 156 of which were operated via the extended iliofemoral approach in 109 patients who had a minimal two years follow-up. The series included 69 women and 40 men, mean age 34 years (11–93). Fracture type was: BC 64; TR+PW 15; T 12; ACH: 3; PW: 2; AC: 2. Delay before surgery was less than 21 days for 76 patients, between 21 days and three months for 22 and greater than three months for 11. There was a femoral head injury in 21% of the cases and 6% had had an earlier operation.

Results: At mean follow-up of 5.4 years (2–12), all fractures had healed. Reduction was anatomic in 69% of the cases, imperfect in 13ù and fair (interfragment gap > 3 mm) in 18%. The mean Postel Merle d’Aubigné score was 15 (5–18) with 63% excellent or good results. Complications were observed in 9% of the cases: seven infections, two serous discharges, and one necrosis of the scar borders. Ectopic ossifications were noted in 56% of the patients, 16% required surgical resection. Total arthroplasty was performed for 7% of the patients, arthrodesis for 4% and haematoma evacuation for 8%. The arthroplasty was revised two years after recurrent dislocation in one patient.

Discussion: This work allows us to conclude that the extended iliofemoral approach is safe and effective for the treatment of complex acetabular fractures. The percentage of excellent and good results is closely related to the quality of the reduction, and can be considered satisfactory known that the extended iliofemoral approach is used for more complex fractures less susceptible of healing. We recommend this approach for experimented operators well trained in the use of the iliofemoral approach.