| ObjectivObjective: To evaluate the results of patients with operatively treatedposterior wall fractures of the acetabulum retrospectively and identifyfactors associated with an adverse outcome.Methods: We reviewed seventy-four patients who had had open reductionand internal fixation of unilateral fracture of the posterior wall of theacetabulum from August 1993 to August 2004. The functional outcome wasevaluated using a modification of the clinical grading system developedby Merle d'Aubignéand Postel. The radiographs were graded according tothe criteria described by Matta.Result: Seventy-four patients were followed for a mean of 4.3 years(range, 2~10.6 years). There were seventy-two males and two females. Theirmean age was 38.9 years (range, 17~58 years). The reduction of the fracture,as determined with plain radiography, was graded as anatomic (0 to 1 mmof displacement) in sixty-six patients, imperfect (2 to 3 mm ofdisplacement) in six and poor (>3 mm of displacement) in two. The clinicaloutcome at the time of final follow-up was graded as excellent in eighteenpatients (24%), good in forty-three (58%), fair in seven (9%), and poorin six (8%). The radiographic result was excellent in thirty-four patients(46%), good in twenty-eight (38%), fair in seven (9%), and poor in five(7%). There was a strong association between the clinical outcome and thefinal radiographic grade. Variables identified as risk factors for an unsatisfactory clinical result included poor fracture reduction,fracture of femoral head, severe heterotopic ossification andosteonecrosis. Complications included heterotopic ossification inseventeen patients (23%), fifteen were graded as Class I~II, two weregraded as Class III~IV. There were eight posttraumatic sciatic nerveinjuries (11%) and three iatrogenic injuries (4%). AVN of the femoral headwas found in three patients (4%). Deep vein thrombosis occurred in twopatients. No patient had a pulmonary embolus. There was no infection.ConclusioConclusion: Anatomic reduction and stable internal fixation is the keyin obtaining satisfactory results in the management of these fractures.Poor fracture reduction, fracture of femoral head, severe heterotopicossification and osteonecrosis are risk factors for an unsatisfactoryclinical result. ObjectivObjective: To evaluate postoperative reduction of acetabular fracturesthoroughly, we measure hip joint contact area using computer-assistedmethod based on CT scan data.Methods: From February 2006 to March 2007, 40 unilateral acetabularfractures were treated operatively. We collected postoperative CT dataof the whole pelvis according to uniform standard. The hip joint contactarea was measured using independently developed software. The fracturereduction measured by hip contact area was compared with assessed by plainradiography. The relation between hip contact area and fracture type wasalso investigated.Result: 40 unilateral acetabular fractures were included in this study.There were 10 females and 30 males. Their mean age was 37.7 years (range,15~60 years). Twenty-one injuries involved the right side, and nineteeninvolved the left. The overall time from injury to surgery averaged 10.3days (range, 4~20 days). Reduction of the fractures, as determined withplain radiography according to the criteria described by Matta, was gradedas anatomic (0 to 1 mm of displacement) in twenty-eight patients (70%), imperfect (2 to 3 mm of displacement) in ten (25%) and poor (>3 mm ofdisplacement) in two (5%). The overall good-to-excellent rate was 95%.The hip contact area was 2399±410mm2 in normal side and 2117±467mm2 inoperated side. The differences were statistically significant. Thecontact ratio between normal side and operated side was 87.3±9.8％.According to the reduction criteria described by Matta, the contact ratiowas 90.5±8.1％in anatomic patients, 81.7±9.5％in imperfect patientsand 70.5±2.1％in poor patients. The differences were statisticallysignificant. The hip contact area of normal side was 1942±221mm2 in 10females and 2551±338mm2 in 30 males. The differences were statisticallysignificant. According to Judet-Letournel classification, thepostoperative hip contact area was different significantly betweenelementary fractures and associated fractures. The differences were alsostatistically significant between posterior wall fractures and posteriorwall with transverse fractures.ConclusioConclusion: Although the reduction of most acetabular fractures weregraded good to excellent by postoperative plain radiography, thedifferences of hip contact area between the operated sides andcontralateral sides were statistically significant. Computer-assistedhip joint contact area measurement based on postoperative CT scan revealsthe fracture reduction thoroughly and quantitively. More research isneeded to investigate the accuracy of this new method and its relationwith clinical results. |
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