Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?

Abstract

Background: Acetabular fractures are complex high-energy injuries. Increasing in recent years with the increased use of high-speed motor vehicles. One of the most important complications of acetabular fracture is the post-traumatic hip osteoarthritis; this complication has been associated to poor fracture reduction, type of fracture and delay in the reduction and fixation of acetabular fracture (Timing surgery). The aims of this study were to determine the incidence of post-traumatic hip osteoarthritis after acetabulum fracture and demonstrate whether the delay surgery is associated to early post-traumatic hip osteoarthritis.

Methods: Using the database of patients with acetabular fractures treated with open reduction and internal fixation (ORIF) over 3 years (2011-2014) with minimum of 2 years follow-up. Data was acquired and saved in a digital format. Demographic information was obtained from each patient with minimum of 2 years follow-up. Acetabular fracture was distributed according to the classification of Judet. The quality of reduction was classified in anatomic (0-1 mm) and non-anatomic (>1 mm) and the timing surgery, early (<7 days) and delay (>7 days). Clinical and radiographic follow-up was generally performed at six weeks, three months, one and two years after fracture fixation. Multivariate logistic regression analyses were performed to assess the strength of the covariates in relation to the development of post-traumatic hip osteoarthritis.

Results: 59 (48%) patients of 122, developed post-traumatic hip osteoarthritis before 2 years. Posterior wall fracture with or without transverse fracture was associated with higher post-traumatic hip osteoarthritis compared with other types of fractures (p < 0.05). Patients with better anatomical reduction had less post-traumatic hip osteoarthritis compared with those who had nonanatomic reduction (p < 0.05). There was no evidence of association between early timing of the surgical procedure and the presence post-traumatic hip osteoarthritis (p = 7092).

Conclusions: According to our results, the anatomical reduction of the articular surface in acetabular fractures is the most important factor in hip osteoarthritis prevention. This factor is strongly associated with early surgical treatment, preferably done within seven days. The timing surgery it is not a factor associated with post-traumatic osteoarthritis.

Keywords: Accuracy of reduction; Acetabular fractures; Delay surgery; Hip osteoarthritis; Post-traumatic; Timing surgery.

Fig. 1

Post-traumatic hip osteoarthritis and type of fracture.

Fig. 2

Post-traumatic hip osteoarthritis distribution with timing surgery and accuracy of reduction.

Fig. 3

The multivariate regression model shows association between accuracy of reduction of fracture and post-traumatic hip osteoarthritis. (p < 0.05).

Fig. 4

The multivariate regression model shows no association between timing surgery of and post-traumatic hip osteoarthritis. (p > 0.05).

Fig. 5

Anterior column fracture.

Fig. 6

Posterior wall fracture with severe upper osteoarthritis with rise of the femoral head.

Fig. 7

Posterior wall fracture with upper outer and inferomedially osteoarthritis.

Fig. 8

Transverse plus posterior wall fracture with upper outer osteoarthritis.

Fig. 9

Transverse fracture.