Operative Treatment Of Displaced Acetabular Fractures

Objective To evaluate the outcome of surgical treatment to the displaced acetabular fractures and investigate the factors influencing the clinical results.Methods From January 1999 to June 2005, 70 cases of displaced acetabular fractures were treated with open reduction and internal fixation. According to Letournel classification, 33 cases were simple fracture and 37 cases of complex fracture. 18 cases combined with cartilage damage of femur head. 46 cases were operated within 2 weeks and 24 cases were operated more than 2 weeks after injury. K-L approachs were applied in 47 cases, ilioinguinal approach in 8, and combined approach in 15. All fractures were fixed by reconstruction plate and lag screw. A statistcical model was constructed comprising the clinic outcome and four postulated prognostic factors( type of fracture,quality of reduction,cartilage damage of femur head and the interval from injury to surgery). The association between these factors and optimal outcome was explored by logistic regression.Results According to Matta standard, anatomic reduction were obtained in 44 cases, satisfactory reduction in 17 cases,unsatisfactory in 5 cases and secondary congruence in 4 cases. All cases were followed from 8 months to 4 years (average 2.5 years). Base on merled Aubigne and Postel's standard, excellent result were achieved in 25 cases, good in 32,fair in 7, and poor in 6 . The total excellence rate of clinical results was 81.4%. Excellent rate in anatomic reduction and non-anatomic reduction groups were of 91.18% and 61.54%.Complications included infection in 2 cases, heterotopic ossification in 3 cases, osteoarthritis in 9 cases, avascular necrosis of the femoral head in 6 cases. Through univariate and multiple Logistic regression analysis, type of fracture was not directly associated with clinical outcome; anatomic reduction of fracture,without cartilage damage of femur head and within 2 weeks after injury were prognostic factors independently with optimal outcome.Conclusions Surgical treatment can attain satisfactory clinical results. There is a...