Predictive value of clinical scoring and simplified gait analysis for acetabulum fractures

Hip Function after Surgically Treated Isolated Traumatic Acetabular Fracture: A Prospective Series of Consecutive Cases

Purpose

Isolated acetabular fractures can occur as a result of a high energy impact on the hip joint. Surgery is required for most patients with an isolated acetabular fracture in order to alleviate pain, restore joint stability, and regain hip function. This study was conducted in order to examine the course of hip function in patients after surgical treatment of an isolated traumatic acetabular fracture.

Materials and Methods

This prospective series of consecutive cases included patients who underwent surgery for treatment of an isolated acetabular fracture in a European level one trauma center between 2016 and 2020. Patients with relevant concomitant injuries were excluded. Scoring of hip function was performed by a trauma surgeon using the Modified Merle d'Aubigné and Postel score at six-week, 12-week, six-month, and one-year follow-up. Scores between 3-11 indicate poor, 12-14 fair, 15-17 good, and 18 excellent hip function.

Results

Data on 46 patients were included. The mean score for hip function was 10 (95% confidence interval [CI] 7.09-12.91) at six-week follow-up (23 patients), 13.75 (95% CI 10.74-16.76) at 12-week follow-up (28 patients), 16 (95% CI 13.40-18.60) at six-month follow-up (25 patients), and 15.50 (95% CI 10.55-20.45) at one-year follow-up (17 patients). After one-year follow-up, the scores reflected an excellent outcome in 11 patients, good in five patients, and poor in one patient.

Conclusion

This study reports on the course of hip function in patients who have undergone surgical treatment for isolated acetabular fractures. Restoration of excellent hip function takes six months.

Functional outcomes more than 5 years following acetabulum fracture

Objectives:

The purposes of this project were to evaluate functional outcomes more than 5 years after acetabulum fracture and to determine factors related to function.

Methods:

This retrospective study consisted of 205 adult patients treated for acetabulum fracture who completed the Musculoskeletal Function Assessment (MFA) a minimum of 5 years following injury. The MFA includes survey of daily activities, gross and fine mobility, social and work function, sleeping, and mood. Higher scores indicate worse function.

Results:

Two hundred five patients with 210 fractures, 69.3% of whom were male, with mean age of 45.7 and mean body mass index 30.1 were included after mean 128 months follow-up. Fracture patterns included OTA/AO 62A (37.1%), 62B (40.5%), or 62C (22.4%), and 80.0% were treated surgically. Late complications were noted in 35.2%, including posttraumatic arthrosis (PTA: 19.5%), osteonecrosis and/or heterotopic ossification. Mean MFA of all patients was 31.4, indicating substantial residual dysfunction. Worse MFA scores were associated with morbid obesity (body mass index >40: 42.3, P>.09), and current tobacco smoking history vs former smoker vs nonsmoker (45.2 vs 36.1 vs 23.0, P < .002). Patients with late complications had worse mean MFA scores (38.7 vs 27.7, P = .001); PTA was the most common late complication, occurring in 19.5%.

Conclusions:

More than 5 years following acetabulum fracture, substantial residual dysfunction was noted, as demonstrated by mean MFA. Worse outcomes were associated with late complications and tobacco smoking. While fracture pattern was not associated with outcome, those patients who had late complications, mostly PTA, had worse outcomes.