DELAYED RECONSTRUCTION OF ACETABULAR FRACTURES 21-120 DAYS FOLLOWING INJURY

A retrospective review was performed of 207 patients treated by delaye d reconstruction of acetabular fracture between 21 and 120 days follow ing injury. Nineteen patients were lost to followup. One hundred eight y seven patients had 188 fractures classified as follows; 35 posterior wall, 9 posterior column, 5 anterior wall, 4 anterior column, 13 tran sverse, 49 transverse/posterior wall, 21 T shape, 8 posterior column/p osterior wall, 8 anterior column posterior hemitransverse, and 34 both column fractures. The average preoperative delay was 43 days. Followu p averaged 6.5 Sears (range, 9 months-30 years). Overall good to excel lent results were achieved in 65% of patients, fair in 9%, and poor in 26%. Good to excellent results by fracture type were; posterior wall (51%), posterior column (89%), anterior wall (60%), anterior column (1 00%), transverse (69%), transverse/posterior wall (59%), T shape (62%) , posterior column/posterior wall (88%), anterior column/posterior hem itransverse (75%), and both column (72%). Heterotopic ossification dev eloped in 49 of 168 patients without prophylactic treatment, in 6 of 1 2 treated prophylactically with diphosphonate, and in 2 of 27 receivin g prophylactic indomethacin therapy. There were 20 postoperative sciat ic nerve palsies, 3 immediate and 5 delayed infections, 5 cases of pul monary embolism, and 26 cases of avascular necrosis. Delayed managemen t of acetabular fractures increases the difficulty of operative treatm ent and may result in a significant reduction in good to excellent res ults. Simple anterior or posterior wall fractures, associated transver se + posterior wall fractures, and T shape fractures have an increased risk of failure when treated within this time period.