[Preparation and technique for surgical treatment of 225 acetabulum fractures. 2 year results of 175 cases]

Abstract

Between December 1986 and November 1995, 222 patients with 225 acetabular fractures were treated operatively by three surgeons in the Department of Traumatology and Emergency Surgery of the University Hospitals of the Catholic University of Leuven. Indications for surgery were unstable fracture, displaced fracture through the acetabular dome and fracture with intra-acetabular fracture fragments. There were 37.3% A-fractures, 49.7% B-fractures, and 13% C fractures according to the AO Classification. In 16.4% of fractures there were primary neurological deficits. Patients were treated operatively after an average of 5.0 days. The Kocher-Langenbeck approach was used in 56.9% of cases, the ilio-inguinal approach in 27.1% and the extended iliofemoral approach in 4%. In 7.1% of patients, a primary total hip endoprosthesis was implanted. There was no intra- oder perioperative mortality. The average hospital stay was 26.1 days. In 7.1% of patients, we noted secondary neurological problems. Deep infections were present in 1.3%. In 11.1% of patients a second operative procedure was necessary. We were able to review 175 patients after an average of 2 years. Signs of arthrosis and periarticular ossification were noted on the x-rays: walking distance, hip mobility and pain intensity were asked about and recorded after the clinical examination. In 76% of patients an excellent or good result on the Merle-d'Aubigne scale was obtained. T-fractures and posterior wall fractures were followed by the worst results. During this 9-year period, changes have been made to the preoperative radiological examination carried out, the choice of operative approach and our policy on prevention of thrombosis prophylaxis and postoperative ossification. After thorough preoperative diagnosis and with a meticulous operative technique, it is possible to stabilise the vast majority of acetabular fractures through the three classical approaches. Because the fractures are relatively rare, their diagnosis complex and their surgical treatment difficult, specific training is essential for every acetabular surgeon.