ACETABULAR FRACTURES: RETROSPECTIVE RADIOCLINICAL STUDY OF 136 PATIENTS AT MEAN 16-YEAR FOLLOW-UP

Abstract

Purpose: Appropriate treatment of fractures of the acetabulum is well known but there is a risk of subsequent degeneration. Few reports of series reviewed after ten years are available. We report a series of 136 treated fractures of the acetabulum with a mean follow-up of 16 years.

Material and methods: Between 1972 and 1996, a total of 554 fractures of the acetabulum were treated. An independent operator reviewed 136 cases. The Judet Letournel classification was applied. Reduction was studied on the AP and 3/4 oblique views of the pelvis using the SOFCOT (November 1981) criteria. Intra- and postoperative parameters (blood loss, complications) were noted. Functional outcome was assessed with the Postel-Merle-d’Aubigné score.

Results: Orthopaedic treatment was used for 38% of the fractures. Forty-one percent were non-displaced and 54% were minimally displaced; 5% of patients had a contraindication for surgery. Reduction was achieved in 28% of the displaced fractures. Among the patients treated orthopaedically, 71% had a good or very good outcome. Anatomic reduction was achieved in 80%. The main complications were sciatic nerve injury (14%), heterotopic ossifications (18%), infection (5%) and intraarticular screws (5%). Good or very good outcome was achieved in 69%. A total hip arthroplasty was implanted in 19% at mean 8 years. Factors significantly related with poor outcome (p< 0.05) were age, posterior displacement, and surgeon experience. There was a good correlation between the function score and radiological signs of osteoarthritis.

Discussion: This is the longest follow-up reported in the literature. For operated patients, the percentage of good and very good outcomes was lower than in other series despite a good rate of anatomic reduction which thus is not a guarantee of good long-term outcome. Other prognostic factors found in the literature include fracture of the femoral head, type of fracture, and quality of the reduction. Long term follow-up remains essential for pertinent analysis of joint surgery.