THE INCIDENCE AND OUTCOME OF NEURAL INJURIES FOLLOWING ACETABULAR FRACTURES

Abstract

Introduction: Acetabular fractures are increasing in incidence and no previous published studies have reviewed the factors influencing the outcome of operative stabilization on the neural function and recovery. The incidence, outcome and recovery of operatively managed acetabular fractures with associated neural injuries were studied from a three-year cohort of patients.

Methods: This retrospective case series study of 456 referrals to a tertiary referral unit, from 1st Jan 2004 to 31st Dec 2006, identified 29 (6.3%) acetabular fractures associated with neural injuries.

The fractures were classified using the Letournel system, neural injuries classified as either complete or incomplete and the degree of post-operative skeletal displacement quantified using radiographs.

A mean clinical and radiographic follow up of 3.5 years was achieved and statistical analysis was performed used chi-squared (SPSS)

Results: Overall, the cohort had a mean age of 34 years, 17 (59%) were male and the mean delay from time of injury to time of acetabular surgery was 16 days (range 4 – 53 days).

All fractures involved posterior wall and/or posterior column and 23 (79%) were of the more complex, associated type, Letournel fracture patterns.

Full resolution of neural symptoms was observed in 9 (31%) patients with a mean fracture reduction of 1.6mm. Partial neurological improvement was observed in 15 patients.

Ongoing complete nerve palsy was observed in 5 patients, associated with a mean fracture reduction of 2.5 mm and a significantly longer delay to surgery of 32 days (p< 0.05).

Discussion: Acetabular fractures involving the posterior wall or column have a high incidence of neural injury. Accurate fracture reduction and stabilization, achieved without a prolonged delay, affords a good neural outcome for these patients. In similiar injuries with complete nerve palsy, delayed and sub-optimal surgical reduction predicts a poor prognosis.