Acetabular fractures: Operative management and long term results

Introduction. While the undisplaced acetabular fractures have a good progno sis after conservative treatment, the management of the displaced fractures has been a controversial issue over the last decades with variable results in their treatment and prognosis. Anatomical reduction can be only achieve d operatively. The long term outcome of 209 patients with displaced acetabu lar fractures treated by open reduction and internal fixation was presented . Material and methods: Between 1972 and 1996, 209 patients with a mean age o f 38 years (15-62a) were treated for displaced acetabular fractures operati vely. 161 patients could be followed up over a period of 2 to 20 years. The function of the hip joint in correlation with radiological results was eva luated according to the scheme of Merle d'Aubinge. Results: Patients with single column fractures showed 90% good or excellent results followed by 55% good or excellent results in patients with transve rse fractures. The highest rates of complication (20% osteoarthritis, 6% fe moral head necrosis, 9% heterotopic ossification) were observed in both col umn fractures and in transverse and posterior wall fractures. Deep infectio n was observed in 6 cases (4%), superficial wound infection in 8 cases (5%) . Primary sciatic nerve palsy was seen in 10 cases (6%) and postoperative p eroneal nerve palsy in 6 cases (4%), all of which improved during the rehab ilitation period. Conclusion: Displaced acetabular fractures of the weight bearing part of th e dome, i.e. transtectal fractures, should be treated operatively. The oper ation should preferably be performed within one week after the injury.