Analysis of Distant Outcomes of Acetabular Fracture Surgery with 30-years' Follow-up (1990-2020).

Abstract

Background: Literature data shows that the incidence of acetabular fractures is 3/100,000 patients/year. Men account for 69.4% of the patients. The mean age is 38.6 +/- 4.6 years and mortality is 3% (1). The causes are high-energy trauma, traffic accidents (80%), and falls from a height (10.7%) (1). Conventional plain radiographs and 2D and 3D CT scans (3) are usually used to assess the extent of damage. The aim of the study was to analyze the determinants of distant outcomes of surgical treatment of acetabular fractures depending on the type of fracture and the degree of reconstruction of the joint surface.

Material and methods: A retrospective analysis was performed of 1,186 patients treated at the Pelvic Trauma and Pathology Ward, Orthopedic Department, Postgraduate Medical Education Centre in Otwock between 1990 and 2020 (30 years). Associated injuries were treated surgically in 29% of cases (n= 344)Results. The radiographic and CT evidence showed that during the early surgical reduction of acetabular fragments, the following results were obtained: very good in 77.2% of the patients (n=916), congruence in 3.9% (n=46), fair in 12.8% (n=152), and poor results in 6% (n=72). Distant outcomes were assessed according to the Merle d 'Aubigne-Postel Score (modified by Matta). Excellent, very good and good results were obtained in 79.8% of patients (n=947), fair results in 8.7% (n=103) and poor results in 11.5% (n=136).

Conclusions: 1. Distant outcomes of surgical treatment of acetabular fractures depend on numerous factors such as: stability of the patient's general condition, which may delay surgical treatment, detailed radiographic and CT assessment, which make it possible to assess the fractures 3-dimensionally and classify them according to the Judet and Letournel classification, degree of anatomical reduction of the fragments, especially in regard to the weight-bearing portion of the acetabulum, visible on postoperative 2D and 3D CT images. 2. Complex fractures according to Judet and Letournel, especially those that involve the posterior wall of the acetabulum or the acetabular dome, have poorer outcomes.