Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital

Abstract

Purpose: Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital.

Materials and methods: Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome.

Results: There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases.

Conclusion: Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome.

Keywords: Acetabular fractures; Harris hip score; Matta radiological grading; Trauma.

Fig. 1. X-ray pelvis (anteroposterior view) of skeletally mature 48 year-old male patient showing transverse fracture with inward subluxation of left hip.

Fig. 2. X-ray pelvis (anteroposterior view) of same patient taken on first postoperative day showing open reduction and internal fixation of left hip with reconstruction plate. Trochanteric osteotomy was performed for better visualization of fracture site and was closed by two cannulated screws.

Fig. 3. (A) X-ray pelvis (anteroposterior view) of skeletally mature 32 year old male patient showing fracture of posterior wall of left acetabulum. (B) X-ray pelvis (anteroposterior view) of same patient showing open reduction and internal fixation with reconstruction plate. Trochancteric osteotomy was performed for better visualisation of fracture site which was closed by two cannulated screws.

Fig. 4. (A) X-ray pelvis (anteroposterior view) of skeletally mature 50 year old male patient showing 10 days old displaced anterior column and medial wall fracture. (B) X-ray pelvis (anteroposterior view) of same patient showing open reduction and internal fixation with inward subluxation of left hip and poor restoration of five anatomical lines.