Acetabular fractures: therapeutic outcome in 60 consecutive cases

Purpose of the study The aim of this study was to analyze clinical and radi ographic results after surgical treatment of acetabular fractures. Material and methods We reviewed 60 consecutive fractures of the acetabulum with loss of joint congruency at mean 5-years follow-up after treatment. T here were 49 men and 11 women, mean age 41 years. According to the R.O. gra ding, the fractures were: 22 class A (33.3%) including 17 type A1, 23 class B (38%) including 10 type B1a2, 14 class C (23.3%) and 1 unclassifiable. E ight of the patients had associated pelvic injury, 40 had hip dislocations and 9 had sciatic nerve injury. Ten femoral head fractures were discovered during the surgical procedure. Three surgical approaches were used: 1) Koch er Langenbeck approach (28 cases), 2) Mears and Rubash triradiate approach (8 cases), 3) extended iliofemoral approach (22 cases), 4) other approaches (2 cases). Anteroposterior and 45 degrees oblique view of the pelvis were obtained for all patients following admission. Computerized tomography scan s were performed in all cases. Fracture displacement and congruency of the femoral head with the roof were documented according to the SOFCOT radiogra phic criteria. The quality of reduction was assessed using the Matta criter ia and the Duquennoy and Senegas criteria. Clinical outcome was assessed at follow-up using the Postel-Merle-d'Aubigne score. Results Anatomic reduction was achieved in 62% of the cases (1 mm or less d isplacement on all views) and congruency of the femoral head with the roof was excellent in 73% of the cases. Clinical outcome was satisfactory in 80% (excellent or good). Operative complications included significant ectopic bone in 21, and in 2 others sciatic nerve palsy that had resolved at 1 year follow-up. Three patients developed avascular necrosis of the femoral head . Discussion Clinical outcome depends on the quality of the reduction. Class C and class B fractures with roof injury should thus be treated by large su rgical exposure. The triradiate approach increases the incidence of ectopic bone. The higher incidence of ectopic bone in patients treated by osteotom y of the trochanter compared with patients without osteotomy of the trochan ter was signifcant (p < 0.05). Avascular necrosis of the femoral head was a ssociated with delayed reduction (66% of the cases). Conclusion Our good clinical results are encouraging; we are pursuing the u se of surgical treatment for displaced acetabular fractures. Clinical outco me depends on the use of the appropriate surgical approach.