Results of operative treatment of acetabular fractures from the Third World--how local factors affect the outcome

Abstract

The objective of this study was to assess the outcome of operations on acetabular fractures from a developing country in the presence of locally available facilities. Sixty-three acetabular fractures were assessed at an average follow up of 52.94 months after operation. Twenty-six patients operated upon in the first three years and 37 operated thereafter were separately studied to discover the effect of the learning curve. Regarding the fractures, 47 of 63 (74.6%) had excellent/good results (Harris Hip Score>80). The complications included broken drill bit in eight patients (12.69%), deep infection and heterotopic ossification in five patients (7.93%), avascular necrosis and sciatic nerve palsy in two patients (3.17%) and implant failure in one patient (1.58%). The results collected during the learning curve were inferior in the complex fractures (p value<0.001). Complications were common in patients opting for local implants and in those operated after over 2 weeks delay.

Fig. 1

a Pre-operative and b final follow up X-ray of a transverse acetabular fracture with posterior dislocation of the femoral head and pubic diastasis. Note the floating ischiopubic fragment. Note also avascular necrosis and mysositis in b

Fig. 2

Broken plate with non-union of the fracture. Note the broken drill bit

Fig. 3

a Intact sciatic nerve in neglected unreduced dislocated head with previous surgery resulting in sciatic nerve injury. b Pre-operative CT scan showing intra-articular fragment and dislocated femoral head. c Final follow up X-ray of the same patient