THE OUTCOME OF SURGICALLY TREATED DISPLACED ACETABULAR FRACTURES AT A MINIMUM OF 10 YEARS FOLLOW UP

Abstract

Purpose: The authors would like to report the outcome following evaluation of surgical treatment for acetabular fractures with more than 10 years follow-up.

Materials and methods: 133 consecutive patients were evaluated with 10–16 years post surgery follow-up (mean 12 years). Mean age was 34 years (17 to 70 range) and male: female were 2:1. 90% of our cases were tertiary referrals. The follow-up assessments included AP pelvis and Judet view radiographs and clinical evaluation was performed with the Harris hip score, Modified Merle d’Aubigne score and the SF 36v2 health survey.

Results: Fracture reduction was anatomical in 69% of the patients and in 31% it was non-anatomical. The reduction of the acetabular fractures was considered anatomical when all five lines on post-operative radiographs were corrected and the hip was congruent. Among our patients, 19% had excellent clinical results according to the modified Merle d’Aubigne Score and 58% according to the Harris Hip Score. A poor clinical outcome was identified in 18% of our patients according to the modified Merle d’Aubigne Score and 23% according to the Harris Hip Score. Radiographic evidence of osteoarthritis was in 35,8% of our patients (all grades of arthritis). 6 of our patients had neurological complications (sciatic nerve palsy) (3 pre-operatively, 2 post- operatively and in one patient there was a delayed sciatic nerve palsy secondary to haematoma). In 7 patients (8.6%) there was heterotopic ossification but in only three that was clinically a problem. Two patients developed intraoperatively pulmonary embolism. We had no post-operative deep vein thrombosis or pulmonary embolism.

Conclusions: Our results compare favourably with those of previous published studies with shorter follow-up period. Anatomical fracture reduction is mandatory and improves the clinical outcome. Infection and avascular necrosis are associated with poor clinical outcome. Early surgical intervention for displaced acetabular fractures can improve the final outcome.