Acetabular Fracture Outcomes and Complications: An International Comparison

Abstract

Introduction: Despite the groundbreaking research by Judet and Letournel in the 1960s, the specific equipment, surgical approach, fixation strategy, and post-operative course for treating acetabular fractures have not been standardized. Therefore, this study aimed to compare technological resources, operative procedures, and post-operative complications between patients treated for acetabular fractures in Romania and the United States (U.S.).

Methods: Between February 2011 and August 2018, a total of 116 Romanian patients and 373 U.S. patients underwent open reduction and internal fixation for acetabular fractures. Data were collected prospectively for Romania and retrospectively for the U.S. The authors used T-tests, Fisher's exact tests, and odds ratios to analyze categorical data while ordinal date were assessed using logistic regression.

Results: U.S. patients had higher comorbidity rates for diabetes, obesity, and hypertension. However, the initial quality of reduction, graded with Matta's criteria, was similar between American and Romanian patients. Post-operatively, U.S. patients had significantly higher Brooker criteria scores for heterotopic ossification. Rates of deep vein thrombosis, infections, sciatic nerve lesions, and loss of reduction between the two countries were not significantly different.

Conclusions: Given the similar initial reduction quality despite technological differences, the authors suggest that fundamental factors, such as surgeon training and experience, may have a greater impact than the availability of technologically advanced operative resources. Future research focusing on the efficacy of these advanced resources for acetabular fracture fixation could help determine their true impact on patient outcomes and improve the cost-effectiveness of this surgery.

Keywords: acetabulum; bones; fracture fixation; fractures; internal; orthopedics.