Radiological Outcomes According to the Matta Score After the Surgical Fixation of Acetabular Fractures

Abstract

Background Acetabular fractures, a rising concern in developing countries, pose a significant challenge due to their complexity and association with post-operative complications. Often caused by high-energy mechanisms like falls and motor vehicle accidents, these fractures require accurate reduction to prevent long-term issues and the potential need for hip replacement. This study investigates the radiological outcomes of acetabular fracture surgery at six months, focusing on the effectiveness of achieving anatomical reduction using the Matta criteria in a low-and middle-income country (LMIC) setting. Methods and materials This prospective study was conducted at a tertiary care center in Pakistan from May 2023 to December 2023, with ethical approval. Patients with isolated acetabular fractures were recruited. Preoperative X-rays and CT scans classified fractures using the Judet and Letournel Classification. Six-month postoperative X-rays were assessed using Matta radiographic criteria. Appropriate statistical analysis was deployed with a significance level at p < 0.05. Results A total of 33 cases met the study criteria, and the mean average age of patients was 44.18 ±17.2 years. Males constituted 87.9% of the cases. Longer hospital stays were associated with poorer outcomes (p < 0.001). Fracture patterns were significant predictors of outcomes (p < 0.001). Six months post-surgery, 45.5% of patients had excellent results, 24.2% had good results, and 15.2% each had fair and poor results according to the Matta radiographic criteria. Avascular necrosis (AVN) developed in 9.1% of patients. Of the 10 patients with femoral head dislocation, only one developed AVN Conclusion This LMIC-based study investigated factors affecting outcomes in patients with acetabular fractures treated using Open Reduction and Internal Fixation (ORIF). We found a relatively younger patient population, and injury patterns suggested a link to the local environment (e.g., traffic accidents). Optimizing hospital stay and timely surgery improved radiological outcomes as assessed by Matta criteria. While limitations exist, the study supports using Matta criteria in LMICs. Additionally, the use of plain radiographs, rather than CT scans, offers a cost-effective and radiation-reducing alternative for post-operative evaluation in resource-constrained settings.

Keywords: acetabular fractures; demographics; developing countries; fracture patterns; hospital stay; lmic-specific classification; matta criteria; orif; radiological outcomes.

Figure 1. Radiological progression of a case with excellent outcome: initial presentation, post-operative (6 weeks), and 6-month follow-up images

The figure shows a sequence of radiological images of a 58-year-old male patient who presented following a motor vehicle accident. Fig. A: X-rays taken on presentation, revealing an anterior with posterior hemi-transverse fracture. Fig. B and C: CT scan 3D reconstruction images providing detailed visualization of the fracture. ORIF (Open Reduction and Internal Fixation) was performed. Fig. D and E: X-rays taken post-operatively, showing the initial results of the surgical intervention. Fig. F, G, and H: X-rays taken 6 months post-operatively, illustrating the progression of bone healing and the patient's condition over time.

Figure 2. Radiological progression of a 60-year-old male with good outcome: initial presentation, post-operative (6 weeks), and 6-month follow-up images

A 60-year-old male presented following a car-on-car road traffic accident, resulting in a right acetabulum fracture with involvement of the anterior column. Fig. A: Initial X-ray revealing a right acetabulum fracture involving the anterior column. Fig. B: Obturator view X-ray of the right acetabulum confirming the anterior column fracture. Fig. C: Axial CT scan of the hip showing a clear anterior column fracture. Fig. D: Sagittal CT scan demonstrating the same anterior column fracture. Fig. E: 3D reconstruction from a CT scan providing detailed visualization of the anterior column fracture. Fig. F: Postoperative X-ray showing the fixation of the fracture. Fig. G: X-ray taken 6 months post-fixation, assessing the healing and alignment of the fracture

Figure 3. Radiological progression of a case with fair outcome: initial presentation, post-operative (6 weeks), and 6-month follow-up image

The figure shows a sequence of radiological images of a 35-year-old patient who presented following a motor vehicle accident. Fig. A: X-rays taken on presentation, revealing a transverse + posterior wall fracture. Fig. B and C: CT scan 3D reconstruction images showing the fracture in greater detail. ORIF (Open Reduction and Internal Fixation) was performed. Fig. D: X-rays taken 6 weeks post-operatively, demonstrating initial healing and hardware placement. Fig. E: X-rays taken 6 months post-operatively, illustrating the patient’s condition and the progression of bone healing.

Figure 4. Radiological progression of a 68-year-old female with poor outcome: initial presentation, post-operative (6 weeks), and 6-month follow-up images

A 68-year-old female presented following a car accident with a poor outcome. Initial imaging confirmed a right acetabulum fracture with a posterior wall fracture. Fig. A: Initial X-ray showing a right acetabulum fracture with a posterior wall fracture. Fig. B: CT scan axial view of the hip, indicating a posterior wall fracture with posterior subluxation of the femoral head. Fig. C: 3D reconstruction CT scan, providing a detailed view of the fracture and associated dislocation. Fig. D: AP view X-ray of the pelvis on postoperative day 1, demonstrating successful reduction and fixation. Fig. E: Obturator view of the right hip postoperatively, showing restoration of the articular surface and reduced femoral head. Fig. F: AP view of the pelvis 5 months postoperatively, depicting reduced joint space. Fig. G: Obturator view of the pelvis 5 months postoperatively, showing maintained reduction but reduced joint space.

Figure 5. Radiological Matta Scores

A horizontal bar graph displaying the distribution of Matta scores, ranging from excellent to fair, among the study cohort. Each bar represents the frequency of patients falling within different score categories, aiding in the visualization of Matta radiographic criteria after surgical fixation of acetabular fracture.