Predictive Factors for Radiological Outcomes following Surgical Treatment of Acetabulum Fractures
Article Sidebar
Main Article Content
Abstract
Objective: The purpose of this study was to evaluate the effects of various factors on radiological outcomes following surgical treatment of displaced acetabular fractures.
Materials and Methods: Radiological outcomes of 81 acetabular fractures which had been surgically treated from October 2014 to September 2017 were evaluated. Factors in the analysis included age, gender, mechanism of injury, smoking, pattern of fractures, time before surgery, initial displacement, and quality of reduction. Multivariate logistic regression analysis was performed to calculate predictive factors.
Results: Of the 81 acetabular fractures, 57 (70.37%) were males and 24 (29.63%) were females. The mean age was 38.67 years (range 15-68). The mechanism of injury in 65 (80.25%) of the cases was a traffic vehicle accident and in 16 (19.75%) it was a fall from height. Of the patients, 25 (31.86%) smoked. Fracture types included simple fractures 30 (30.07%) and associated fractures 51 (62.96%). The mean time to surgery was 15.07 days (range 1-59). There was an associated hip dislocation in 27 cases (33.33%), initial fracture displacement ≤ 20 mm in 61 cases (75.31%) and displacement > 20 mm in 20 cases (24.69%). Of the fracture reductions, 20 (20.49%) were anatomical reductions, 26 (32.20%) were categorized as good reductions and 35 (43.21%) were rated as poor reductions. Radiological outcomes were good in 35 cases (43.21%), fair in 23 cases (28.40%) and poor in 23 cases (28.40%). None of the cases had an excellent outcome. Age, gender, mechanism of injury, and time to surgery were not correlated with radiological outcomes. Variables that were statistically significantly associated with outcomes were quality of reduction (p=0.000), initial displacement (p=0.007), fracture pattern (p=0.021) and associated hip dislocation (p=0.030).
Conclusions: Poor reduction, initial displacement ≥ 20 mm, associated hip dislocation, and fracture pattern are correlated with a poor outcome prognosis for surgically treated acetabular fractures.
Article Details
References
2. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996; 78(11): 1632-45.
3. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction: preliminary report. J Bone Joint Surg Am. 1964; 46: 1615-46.
4. Judet R, Judet J, Letournel E. Fractures of the acetabulum:classification and surgical approaches for open reduction. J Bone Joint Surg Am. 1964; 46: 1615-38.
5. Matta JM, Mehne DK, Raffi R. Fractures of the acetabulum: early results of a prospective study. Clin Orthop Relat Res. 1986; (205): 241-50.
6. Meena UK, Tripathy SK, Sen RK, Aggarwal S, Behera P. Predictors of postoperative outcome for acetabular fractures. Orthop Traumatol Surg Res. 2013; 99(8): 929-35.
7. Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br. 2005; 87(1): 2-9.
8. Briffa N, Pearce R, Hill AM, Bircher M. Outcomes of acetabular fracture fixation with ten years’ follow-up. J Bone Joint Surg Br. 2011; 93(2): 229-36.
9. Bhandari M, Matta J, Ferguson T, Matthys G. Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip. J Bone Joint Surg Br. 2006; 88(12): 1618-24.
10. Letournel E, Judet R. Fractures of the acetabulum. Elson RA, ed. New York: Springer-Verlag, 1993.
11. Kreder HJ, Rozen N, Borkhoff CM, Laflamme YG, McKee MD, Schemitsch EH, et al Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall. J Bone Joint Surg Br. 2006; 88(6): 776-82.
12. Iqbal F, Taufiq I, Najjad MK, Khan N, Zia OB. Fucntional and radiological outcome of surgical management of acetabular fractures in tertiary care hospital. Hip Pelvis. 2016; 28(4): 217-24.
13. Zha GC, Yang XM, Feng S, Chen XY, Guo KJ, Sun JY. Influence of age on results following surgery for displaced acetabular fractures in the elderly. BMC Musculoskelet Disord. 2017; 18(1): 489.
14. Negrin LL, Seligson D. Results of 167 consecutive cases of acetabular fractures using the Kocher- Langenbeck approach: a case series. J Orthop Surg Res. 2017; 12(1): 66.
15. Anizar-Faizi A, Hisam A, Sudhagar KP, Moganadass M, Suresh C. Outcome of surgical treatment for displaced acetabular fractures. Malays Orthop J. 2014; 8(3): 1-6.
16. El-Khadrawe TA, Hammad AS, Hassaan AE. Indicators of outcome after internal fixation of complex acetabular fractures. Alexandria Med J. 2012; 48(2): 99-107.
17. Shin JK, An SJ, Go TS, Lee JS. Analysis of predictors of results after surgical treatment of acetabular fractures. Hip Pelvis. 2015; 27(2): 104-9.