OUTCOME OF PELVIC & ACETABULAR RECONSTRUCTION IN A DISTRICT GENERAL HOSPITAL IN UK

Abstract

The purpose of this study is to evaluate the effectiveness of current surgical management of pelvic acetabular fractures providing insight into the outcomes of fractures treated operatively using validated scoring systems.

20 Patients were surgically treated over a 2 year period at the Hudders field Royal Infirmary Hospital, United Kingdom. All were operated on by a single surgeon following pelvic and acetabular fractures. The first part of the study consisted of a review of the clinical records and x-rays done by 2 different observers. All the pelvic fractures were classified according to the Young-Burgess classification, and acetabular injuries according to the Letournels classification. The notes were assessed for probability of survival on admission and ‘ISS scoring’. The clinical records were reviewed for post operative complications, a protocol for follow up management, involvement of HDU, and any relevant re-admissions. The second portion of the retrospective study consisted of patient reviews at the clinic, the minimum being 6 months post operatively. Recent x-rays were reviewed for bone healing, heterotrophic ossification and avascular necrosis. The patients wound healing was assessed. Clinical results were recorded using the Oxford Hip score and the SF-36.

The results were analysed whilst ISS scoring varied from 8–32 with most of the patients. All patients had a good reduction and fracture healing. Complications noted were wound infection in 5%, and heterotrophic ossification in 5%. There were no nerve palsys, no DVT or pulmonary embolus, and no patients had avascular necrosis of the femoral head. Most patients had returned to near normal activities, with low pain scores. The Oxford Hip score ranged between 12–25, and the SF-36 score between 80 & 100.

The authors concluded that patients with complex acetabular fractures can be managed effectively in a district hospital set up. Osteoarthrosis of the hip can be avoided if an anatomical reduction is achieved.