Outcome of surgical treatment for displaced acetabular fractures: a prospective study

Rates and risk factors of complications associated with operative treatment of pelvic fractures

PURPOSE

Post-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery.

METHODS

A retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (≥ 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications.

RESULTS

Complications occurred in 55 (24%) of the 233 included patients. SSI's were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00-1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29-7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%).

CONCLUSION

Limiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery.

Outcome of acetabulum fractures treated with open reduction and internal fixation through Kocher-Langenbeck Approach: A retrospective study

BACKGROUND

Complex anatomy of acetabular fracture is quite challenging for the orthopedic surgeons. Many Acetabular fracture fixation approaches have been used for a long time to treat different fracture patterns of acetabulum. Kocher-Langenbeck Approach (K-L approach) of acetabulum fracture is usually used by most of orthopedic surgeons. In this retrospective study, we evaluated the clinical and functional outcome of subtypes of acetabulum fractures treated with K-L approach. Assessment of Intra and postoperative complications of subtypes of acetabulum fractures was also done.

METHOD

Eighty patients (48 men and 32 women) were included in this retrospective study with a mean follow-up period of 2.6 years. Fractures were classified according to Letournal and Judet classification. K-L approach was performed in all these patients. Post operative reduction, Radiological outcome was quantified using Matta's criteria while the functional outcome was assessed according to Merle d'Aubigné and Postel scoring system. Postoperative complications were evaluated.

RESULTS

The mean age of a total of 80 cases was 43.64 ± 13.24 year. The type of fracture was found to be significantly associated with concentric/non-concentric reduction (p = 0.003) and with post op reduction (p = 0.005). The post operative reduction was found to be significantly associated with radiological (p < 0.001) and functional outcome (p < 0.001) at one year post op. The type of fracture was found to be significantly associated with radiological outcome (p < 0.001) while non-significantly found to be associated with functional outcome at 1 year (p = 0.050). The type of fracture was found to be significantly associated with post op complications (p = 0.003) and with arthritis (p = 0.001).

CONCLUSION

K-L approach is a multifaceted and convenient approach for treating acetabulum fractures. Type of fracture and post-operative reduction are key factors for a satisfactory outcome. Transverse with posterior wall fracture has the worst prognosis.

Factors affecting the functional outcome of surgically managed displaced acetabular fractures

PURPOSE OF STUDY

To evaluate the impact of various factors on functional outcome of surgically managed displaced acetabular fractures.

METHODS

In this prospective study 50 cases of surgically managed displaced acetabular fractures were followed up to a mean of 28.6±4 months (18-48 months). The effect of age, associated injuries, fracture pattern (elementary/associated type), time to surgery (<2 weeks/>2 weeks), accuracy of reduction (anatomical/imperfect/poor), gender and associated hip dislocation on the clinical outcome was evaluated using Harris hip score and modified Postel Merle d'Aubigné score.

RESULTS

The mean age was 36.6±11.9 years (range 19-67 years). There were 76% (n=38) males and 24% (n=12) females. 82% (n=41) patients sustained fracture due to motor vehicle accident. 60% of the cases had associated injuries. The mean Harris hip score at final follow-up was 80.96±8.9 and mean modified Merle d'Aubigné and Postel score was 15.1±2.4. The Harris Hip score and modified Postel Merle d'Aubigné score was significantly affected by presence of associated injuries (P=0.0025 and 0.0037 respectively), time to surgery (P=0.0087 and 0.0093 respectively), fracture pattern (P=0.015 and 0.023 respectively), associated hip dislocation (P=0.011 and 0.008 respectively), accuracy of reduction (P<0.05) and age (P<0.05), but gender (P=0.78 and 0.93 respectively) didn't have any significant effect on the clinical outcome.

CONCLUSION

The presence of associated injuries, concomitant hip dislocation, associated type of fracture patterns, elderly age (more than 60 years), sub optimal fracture reduction and delay in surgery beyond 2 weeks are factors that lead to statistically significant suboptimal functional scores.

Surgical Treatment for Posterior Dislocation of Hip Combined with Acetabular Fractures Using Preoperative Virtual Simulation and Three-Dimensional Printing Model-Assisted Precontoured Plate Fixation Techniques

Background and Purpose

Hip dislocation combined with acetabular fracture remains a challenging condition for orthopedic surgeons. In this study, we utilized a computer-assisted simulation and three-dimensional (3D) printing technology to treat patients with hip dislocation combined with acetabular fracture. We hypothesized that the 3D printing-assisted method would shorten the internal fixation time and surgical time.

Methods

We retrospectively reviewed 16 patients diagnosed with traumatic posterior dislocation of hip combined with acetabular fractures and treated with plate fixation from September 2013 to August 2017. Patients were divided into two groups: (1) traditional method and (2) 3D printing groups. In the traditional method group, the plates were contoured during the surgery, whereas in the 3D printing group, the patient's pelvic computed tomography image was transformed to the 3D medical image software for processing preoperatively. The fracture reduction was simulated by the computer. Thereafter, the 1:1 scale 3D printing model was used to design the surgical plan and contour patient-specific plates preoperatively.

Results

The internal fixation time was significantly shorter in the 3D printing group than in the traditional method group (-33 min, P<0.05). The mean operative time was shorter than that in the traditional method group (-43 min). However, blood loss and postoperative radiograph results were similar between the groups. The complication rate was lower in the 3D printing group (2/7) than in the traditional method group (5/9).

Interpretation

Computer-assisted simulation with 3D printing technology is a more efficient method for treating hip dislocation combined with acetabular fractures.