Comparison of Percutaneous Screw Fixation to Open Reduction and Internal Fixation in Acetabular Fractures: A Matched Pair Study Regarding the Short-Term Rate of Conversion to Total Hip Arthroplasty and Functional Outcomes

Abstract

Closed reduction and percutaneous internal fixation (CRPIF) for acetabular fractures was introduced as a less invasive alternative to open reduction and internal fixation (ORIF) for moderately displaced fractures. Currently, comparisons of ORIF and CRPIF outcomes are rare. Twenty-three patients treated with CRPIF were matched with patients treated with ORIF based on sex, age, and fracture classification. Surgery-dependent and -independent factors of the in-hospital stay, the conversion rate to total hip arthroplasty (THA), and quality of life were assessed. The ORIF group had a higher preoperative fracture step (p = 0.04) and gull wing sign (p = 0.003) compared with the CRPIF group. Postoperatively, the gap and step size were not significantly different between the groups (p > 0.05). CRPIF required less time (p < 0.0001) and transfusions (p = 0.009) and showed fewer complications (p = 0.0287). Four patients were converted to THA (CRPIF, n = 1; ORIF, n = 3; p = 0.155) because of posttraumatic osteoarthritis. Functional outcomes and pain were similar in both groups (p > 0.05). The present study revealed less blood loss and a lesser extent of reduction in patients treated with CRPIF than in those treated with ORIF. The rates of conversion to THA and functional outcomes did not differ between CRPIF and ORIF. CRPIF appeared to be a valuable treatment option for selected patients.

Keywords: acetabular fractures; closed reduction and percutaneous internal fixation; total hip arthroplasty.

Figure 1

Protocol of the investigation. After matching closed reduction and percutaneous internal fixation (CRPIF) patients to open reduction and internal fixation (ORIF) patients, the presented in-hospital data were obtained. Afterward, patients were asked to participate in the follow-up examination. Patients who received total hip arthroplasty (THA) after one postoperative year were noted. If patients received no THA, the functional outcome and quality of life were assessed using the presented instruments. * Two patients refused to fill out the EQ-5D TTO. Body mass index, BMI; American Society of Anesthesiologists grading, ASA; Charlson Comorbidity Index, CCI; difference between pre- and postoperative hemoglobin concentration, ∆Hb_pre-post; red blood cell, RBC; hospital-acquired death, HAD; surgical complications, SC; general complications, GC; visual analog scale, VAS; range of motion, ROM.

Figure 2

Distribution within the used scores without significant differences between the groups.