Clinical Results In Surgically Treated Displaced Acetabular Fractures

Background:Fractures of the acetabulum are high-energy trauma injuries and are often accompanied with other complications such as fractures of upper or lower extremities, head, thorax, abdomen, genitourinary or sciatic nerve injuries,morbidity is high. Fractures of the acetabulum pose a difficult problem for the patient and the surgeon because of the complicated anatomic structure, severity of combined injury and possible postoperative complications of posttraumatic osteoarthrosis,osteonecrosis of the femoral head, and heterotopic ossification (HO). In 1964, Judet and Letournel published a classification system and they suggested surgical treatment of all displaced acetabular fractures that became widely accepted and made great progress to the treatment of acetabular fracture. Most commonly, treatment of nondisplaced fractures is conservative with good prognosis,but displaced fractures need surgically treatment. In a comparative study, nonoperative treatment of the displaced acetabular fracture has been shown to give far inferior results compared to operative treatment (30% good results versus 86% good results). The goal of treatment of a displaced acetabular fracture is to achieve anatomical reduction of the articular surface with rigid internal fixation to allow early joint motion, but the choice of surgical approach remains controversial. For a simple fracture pattern involving one column there is uniform consensus that only a single anterior or posterior surgical exposure is required, however, for complex fractures, various different approaches have been used. These include extended iliofemoral,triradiate approach,"T"extensile approach and combined anterior and posterior approaches .but there is higher rate of complications like infection, heterotopic ossification and increased postoperative morbidity with the use of these approaches. As a result there is now more emphasis on using a single approach for operative management of a displaced acetabular fracture.Objective:To study the result of surgical treatment of displaced acetabular fracture.Methods:From January 2004 to December 2006, 32 patients (20 male and 12 female) underwent an open reduction and internal fixation of their displaced acetabular fracture , with an average age of 39 years ( 18 to 68 ). On the basis of X-ray and computed tomography, all fractures were classified according to the Letournel-Judet classification, 7 cases were simple fractures and 25 were complicated ones. Kocher-Langenbeck approach ( 15 cases) , illioinguinal approach (12 cases) ,extended iliofemoral(2 cases) and anterior combined posterior approach(3 cases) were adopted for different fractures with reconstruction plates and screws.Result:All cases were followed up for average 44 months (24 to 70 months). According to Jedut criterion , 21 cases were reduced anatomically , 6 cases were reduced satisfactory , and 5 cases were poor. At the final follow-up, the patients were evaluated clinically according to modified D'Aubigne-Postel scoring system and radiologically based on the criteria described by Matta. The clinical results were excellent in 11 patients, good in 13, fair in 5 and poor in 3 . The radiological results were excellent in 10 patients, good in 13, fair in 4 and poor in 5 . Avascular necrosis of the femoral head was found in 2 cases, heterotopic ossification in 2 cases, Brooker gradeâ… in 1 case, Brooker grade II in 1 case, traumatic arthritis in 3 cases. No death, infection or nonunion were found.Discussion: The treatment of fractures of the acetabulum as any intraarticular fracture is based on a precise anatomical reduction, stable fixation and early mobilization. Difficulties of the treatment of the acetabulum arise from the anatomical structure and the type of fracture. Decisive for the indication and opportunity of surgically treatment is connected with the outcomes. In order to understand the type of the fracture it is necessary to make X-rays and CT examination, and according to the type of the fracture can we make decision for surgical approach, method of reduction and type of fixation. The outcomes depend directly on the quality of the reconstruction of the articular surface and the incidence of complications.Conclusion:Enough image data, appropriate classification, operation on time, reasonable surgical approach, anatomic reduction, firm fixation and early functional rehabilitation are essential for reaching a good clinical result of displaced acetabular fracture.