Long-Term Outcome of Conservatively Managed Displaced Acetabular Fractures

Surgical Versus Nonsurgical Management of Acetabular Fractures With Associated Patterns in Elderly Patients: Factors Affecting Outcomes

INTRODUCTION

Among elderly patients, anterior column posterior hemitransverse (ACPHT) and associated both column (ABC) are common acetabular fracture patterns after low-energy mechanisms. Given the paucity of outcomes data in this cohort, the goal of this study was to determine the favorability of results with surgical versus nonsurgical management. Secondarily, factors linked with poor functional outcomes were assessed.

METHODS

Over a 16-year period, 81 patients aged ≥60 years with 82 ACPHT and ABC acetabular fractures were evaluated. Retrospectively, patient demographics, injury details, and early and late complications were collected. Functional outcomes were assessed with the Musculoskeletal Function Assessment (MFA) after a minimum of 12 months of follow-up.

RESULTS

During the study period, 81 patients sustained 82 ACPHT (n = 35, 43%) or ABC (n = 47) fractures, most secondary to low-energy falls (71%). Patients managed surgically were younger, had higher-energy mechanisms, and more often had an associated hip dislocation or marginal impaction (all P < 0.05). Of note, 42.3% and 18.5% of patients had early and late complications, respectively, with no differences between surgical and nonsurgical groups. Posttraumatic arthrosis (PTA) was noted in 27% overall (36% surgical versus 16% nonsurgical, P = 0.10). The mean MFA score was 25.2 after 59 months. Better outcomes were associated with high-energy mechanisms, multiple injuries, and surgical management (all P < 0.05). The worst MFA outcomes were among patients with PTA (40.2) and those requiring a secondary procedure (45.7), both P < 0.05.

DISCUSSION

Nonsurgical management had a low rate of PTA. Mitigating PTA and decreasing the rate of secondary surgeries seem crucial achieving satisfactory outcomes. Higher-energy injuries benefit from open reduction and internal fixation, as indicated by better MFA scores.

Sequence of Fixing Fractures Involving all the Three Major Joints of the Upper Limb: A Case Report

A 29-year-old lady accidentally fell from the first floor at home, sustained multiple fractures all on the left side which were the proximal humerus fracture, inter-condylar distal humerus fracture, intra-articular distal end radius fracture, and acetabulum fracture. She was actively managed following Advance Trauma life Support (ATLS) protocol and once stabilised was operated in a stage-wise manner for all the fractures. This case report is about the unusual presentation of multiple fractures involving all the three ipsilateral major joints of the upper limb in an adult following a fall from a height and highlights the uniqueness of the fracture's presentation and effective surgical management for better outcomes and rehabilitation.

Acetabular fractures in the elderly: modern challenges and the role of conservative management

Introduction 

The incidence of acetabular fractures in the elderly population is ever increasing. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery.

Aim 

This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly.

 Conclusion

Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes.

Minimally displaced acetabulum fractures in geriatric patients: a comparison of open, percutaneous and non-operative treatment from the German Pelvic Injury Register data

Purpose

In elderly patients with minimally displaced acetabulum fractures, the patients’ inability to partially weight-bear and the need for early mobilisation may trigger the decision towards a treatment with higher primary stability. The purpose of this study was to compare open reduction and internal fixation (ORIF), closed reduction and percutaneous fixation (CRPIF) and non-operative treatment in geriatric minimally displaced acetabulum fractures with regard to complications and quality of reduction.

Methods

Data from the prospective German Pelvic Injury Register collected between 2008 and 2018 were used to evaluate 608 geriatric patients with isolated minimally displaced (≤ 5 mm) acetabulum fractures. In total, 429 received non-operative treatment, 117 ORIF and 62 CRPIF. Demographics, injury severity, fracture pattern, complications and fracture displacement before and after treatment were analysed.

Results

Both operative methods reduced fracture gap displacement. CRPIF was associated with lower blood loss and shorter operative time compared to ORIF (p < 0.001). Hospital stay was 12.9 days in the non-operative group, 16.8 with CRPIF and 23.6 with ORIF (p < 0.001). Non-surgical general complications were more likely to occur following ORIF (22.2%) compared to CRPIF (8.1%) and non-operative treatment (8.4%, p < 0.001). The rate of surgical complications was not different for ORIF and CRPIF (p = 0.122)

Conclusion

Both operative treatments improve fracture displacement and joint congruency in elderly patients with minimally displaced acetabulum fractures. Compared to ORIF, CRPIF achieves similar quality of reduction but is associated with fewer complications, smaller intraoperative blood loss, shorter operative time and shorter length of hospital stay.

Neglected acetabular fracture: Fix or replace?

INTRODUCTION

Operative treatment of acute acetabular fractures has shown better results than the non-operative approach. There is, however, limited data regarding the operative treatment of neglected acetabular fracture.

METHODS

We present six subjects with neglected fracture of the acetabulum in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia. One had only open reduction and internal fixation, three had open reduction and internal fixation first before we performed arthroplasty later, one had both open reduction and internal fixation with arthroplasty, and another had immediate arthroplasty.

RESULTS

Our subjects were 4 males and 2 females with the average age of 41.1 years and the average neglect period was 18 months. In four of our subjects, the fractures had posterior wall involvement, one had an anterior column-posterior hemitransverse fracture, and the last one had transverse fracture. All fractures were classified to either Elementary or Associated type according to the Letournel classification. We observed all subjects up to eighteen months post-operatively. One subject had poor outcome, four subjects had fair outcome, and one subject had excellent outcome according to the Harris Hip Score.

CONCLUSION

Even in neglected acetabular fracture, open reduction and internal fixation where possible should be attempted to restore the anatomical relationship to facilitate immediate or late total hip arthroplasty. Surgical treatment of such fractures should be based on individual case characteristics, which includes age, associated comorbidity, neglect period, as well as the type and union state of the fracture for a better outcome. Neglected Associated acetabular fracture types are more difficult to reduce and have poorer outcome compared to Elementary types. Likewise, malunited acetabular fractures are more difficult to operate on than non-united neglected acetabular fractures, where reduction is relatively easier.

Management of Acetabular Fractures in the Elderly

The incidence of acetabular fractures in the elderly population is increasing. Fractures in this population differ from those in younger patients, with more frequent involvement of the anterior column, more comminution, and more severe articular impaction in elderly patients. Although acetabular fractures in geriatric patients are more likely the result of low-energy trauma, outcomes are generally poorer than those in young patients. Multiple management options have been proposed, but no intervention has become the standard of care for these fractures in the elderly. Patient characteristics (eg, prior ambulation status, functional capacity, bone quality), the nature of the fracture, and the experience of the treating orthopaedic surgeon all must be considered when choosing among nonsurgical treatment, percutaneous fixation, open reduction and internal fixation, and immediate or delayed arthroplasty. Each treatment option has the potential for satisfactory results in properly selected patients.

Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?

BACKGROUND

Acetabular fractures are complex high-energy injuries. Increasing in recent years with the increased use of high-speed motor vehicles. One of the most important complications of acetabular fracture is the post-traumatic hip osteoarthritis; this complication has been associated to poor fracture reduction, type of fracture and delay in the reduction and fixation of acetabular fracture (Timing surgery). The aims of this study were to determine the incidence of post-traumatic hip osteoarthritis after acetabulum fracture and demonstrate whether the delay surgery is associated to early post-traumatic hip osteoarthritis.

METHODS

Using the database of patients with acetabular fractures treated with open reduction and internal fixation (ORIF) over 3 years (2011-2014) with minimum of 2 years follow-up. Data was acquired and saved in a digital format. Demographic information was obtained from each patient with minimum of 2 years follow-up. Acetabular fracture was distributed according to the classification of Judet. The quality of reduction was classified in anatomic (0-1 mm) and non-anatomic (>1 mm) and the timing surgery, early (<7 days) and delay (>7 days). Clinical and radiographic follow-up was generally performed at six weeks, three months, one and two years after fracture fixation. Multivariate logistic regression analyses were performed to assess the strength of the covariates in relation to the development of post-traumatic hip osteoarthritis.

RESULTS

59 (48%) patients of 122, developed post-traumatic hip osteoarthritis before 2 years. Posterior wall fracture with or without transverse fracture was associated with higher post-traumatic hip osteoarthritis compared with other types of fractures (p < 0.05). Patients with better anatomical reduction had less post-traumatic hip osteoarthritis compared with those who had nonanatomic reduction (p < 0.05). There was no evidence of association between early timing of the surgical procedure and the presence post-traumatic hip osteoarthritis (p = 7092).

CONCLUSIONS

According to our results, the anatomical reduction of the articular surface in acetabular fractures is the most important factor in hip osteoarthritis prevention. This factor is strongly associated with early surgical treatment, preferably done within seven days. The timing surgery it is not a factor associated with post-traumatic osteoarthritis.

Long-Term Survival of the Native Hip After a Minimally Displaced, Nonoperatively Treated Acetabular Fracture

BACKGROUND

Few studies have evaluated the long-term results for nonoperatively treated acetabular fractures. The purpose of this study was to describe the long-term survival of the native acetabulum as well as the clinical and radiographic outcome for patients with nonoperatively treated acetabular fractures.

METHODS

All patients with acetabular fractures are prospectively registered in our acetabular fracture database and followed up at regular intervals for up to 20 years. We identified 236 patients (237 fractures) who had been treated nonoperatively between 1994 and 2004; 51 patients with incomplete data were excluded. For the survival analysis, 186 fractures with an average follow-up of 9 years (range, 1 to 20 years) were included. For the long-term clinical outcome, 104 patients with an average follow-up of 12.1 years (range, 9 to 20 years) were included.

RESULTS

The 10-year survival of the native hips was 94% (111 hips were at risk). Eighty-nine percent of the patients had a good or excellent Harris hip score, and 88% had a good or excellent Merle d'Aubigné and Postel score. The most important negative predictor for clinical outcome and survival of the hip was a fracture step-off of ≥2 mm measured in the obturator oblique radiograph.

CONCLUSIONS

Nonoperative treatment of minimally displaced acetabular fractures yields good to excellent long-term results. For patients with a questionable indication for fracture surgery, oblique radiographs (Judet views) are a helpful tool in the decision-making process, as a fracture step-off of ≥2 mm is a strong predictor for a poor clinical and radiographic result at 10 years.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Management of neglected acetabular fractures

Management of neglected acetabular fractures is a difficult task. Osteosynthesis in such cases may not be an ideal solution because of the femoral head damage due to pressure by the fractured acetabular edge, avascular necrosis, difficulty in mobilizing the fragments due to callus formation, difficulty in indirect reduction of the fracture fragments and macerated acetabular fragments all contributing to inadequate fracture reduction. Majority of such fractures are now treated with total hip replacement. While treating such fractures with THR, problems associated with neglected acetabular fractures such as fracture non-union, hip dislocation, protrusio, cavitary bone defect or peripheral bone defect must be considered. 3D computed tomography scan provides a clear view about the acetabular and periacetabular bony anatomy. Impaction grafting and antiprotrusio cage or ring with a cemented acetabular cup can address most of the hip protrusio and cavitary bone defects. Segmental bone defect needs cortical strut-bone graft fixation and subsequent implantation of a cemented or uncemented acetabular cup implantation. Fracture non-union needs approximate reduction and fixation with plates followed by bone grafting and implantation of an acetabular cup. Despite these efforts, the outcome of THR in neglected acetabular fracture is considerable worse than after conventional hip replacement.

Positron emission tomography-computed tomography in the assessment of viability of femoral head in acetabular fractures

PURPOSE

The aim of this study was to use positron emission tomography-computed tomography (PET-CT) imaging as a tool for assessment of viability of femoral head in acetabular fractures and help in early detection of complications like avascular necrosis (AVN) of the femoral head.

METHODS

In our study PET-CT was done pre-operatively and six weeks postoperatively in 31 patients who underwent open reduction and internal fixation (ORIF) of acetabular fractures and fracture-dislocations. There were 26 male and five female patients who were treated in our institute between January 2009 and July 2010. Patients were subsequently followed up with plain radiographs for a mean period of 3.8 years and minimum of two years.

RESULTS

Although seven out of 31 patients showed avascularity of the femoral head on PET-CT in the pre-operative period, only two patients progressed to AVN at final follow up, whereas the other five patients regained the vascularity at the end of six weeks. There was no statistically significant correlation between vascular status on pre-operative scan and the presence of AVN on final follow-up radiograph. There was a significant correlation between avascularity of the femoral head on the sixth week PET-CT and AVN in the final radiograph.

CONCLUSION

PET-CT seems to be useful as a prognostic investigation in the assessment of the vascular status of the femoral head following injuries around the hip. Both pre-operative and postoperative imaging are necessary to understand the time-dependent changes in blood flow following injury.

Acetabular fracture: long-term follow-up and factors associated with secondary implantation of total hip arthroplasty

HYPOTHESIS

The present study sought to determine long-term outcome in acetabular fracture and the factors associated with secondary implantation of a total hip arthroplasty and/or with poor functional results.

MATERIAL AND METHODS

Seventy-two patients admitted between 2000 and 2005 were followed up for a maximum 11 years (mean, 6.8 years): 16 females, 56 males; mean age at injury, 41.6 years (median, 40 years). There were 45 simple acetabular fractures, 27 complex fractures and 27 dislocations. Late complications were: osteoarthritis (n=29), osteonecrosis of the femoral head (ONFH: n=8) and heterotopic ossification (n=2).

RESULTS AND DISCUSSION

Twenty-five total hip arthroplasties (THA) were performed, with a mean time to surgery of 3.7 years. Associated factors for THA were: VAS (P<0.0001), PMA (P<0.0001), osteoarthritis (P<0.0001), ONFH (P<0.0002), initial dislocation (P=0.0002), no functional treatment (P=0.0014), surgical treatment (P=0.0065), initial traction (P=0.0068), anterior and posterior congruency defect (P=0.0072 and P<0.0001), and initial intra-articular foreign body (P=0.045). Factors associated with poor or bad functional results were the same, plus: etiology (P=0.0021), BMI (P=0.03) and posterior wall fracture (P=0.0325).

LEVEL OF EVIDENCE

4; retrospective study.

Management of high-energy acetabular fractures in the elderly individuals: a current review

Acetabular fractures in the elderly individuals are increasing in prevalence. Although there is evidence in the literature that acetabular fractures in elderly patients sustained as a result of low-energy mechanisms can be well treated by nonoperative management, open reduction and internal fixation, or even acute arthroplasty, almost no literature exists that may appropriately guide the treatment of elderly acetabular fractures that occur as a result of high-energy mechanisms. In spite of this lack of evidence, specific principles for providing the best care in adult trauma patients may reasonably be adopted. These principles include aggressive resuscitation and medical optimization; surgical care that focuses on a patient's survival but does not sacrifice skeletal stability; and early mobilization. Best practices that guide the care of hip fracture patients, such as a team approach to care, the use of protocols to guide treatment, and the timing of surgery to occur as soon as is safely possible also should be employed to guide care in patients who have sustained acetabular fractures. Opportunity exists to better study these higher energy fractures and to, thereby, affect outcomes in patients who have sustained them.

Fractures of the acetabulum in elderly patients: an update

The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented.

[Acetabular fractures: short-term results]

OBJECTIVE

To evaluate the results of surgical treatment of displaced acetabular fractures, and to discern which variables influence the final radiological and clinical outcome.

METHODS

We retrospectively analyzed 23 patients who underwent open reduction and internal fixation of acetabular fracture with a mean age of 40.4 years (17-72 years). Mean follow-up was 4 years (1.5-7.5 years). According to Judet and Letournel classification, we operated 10 simple fractures (43.5%) and 13 complex (56.5%), with both-column fractures being the most common type (8 hips). We evaluated the quality of reduction achieved, the clinical results and the occurrence of coxarthrosis.

RESULTS

We obtained anatomic reduction of the lesion in 12 cases (52%), in 7 (30%) residual displacement was less than 2mm, and in 4 patients (17%) greater than 2mm. According to Harris' score, the clinical outcome was excellent or good in 18 cases (78%) and fair or poor in 5 (22%), getting worse in complex fractures and when we do not reach an anatomic reduction of the injury. Six patients (26%) developed moderate or severe degenerative changes during follow-up. The degree of postoperative reduction obtained was identified as the main predictor of the development of post-traumatic osteoarthritis.

DISCUSSION AND CONCLUSIONS

The acquisition by open reduction and internal fixation of an accurate congruence between the femoral head and acetabulum is essential to achieve good long-term results.

Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation

OBJECTIVES

To present the functional outcomes of elderly patients treated with percutaneous acetabular surgery and compare them with those treated with traditional open reduction and internal fixation in previously published series.

DESIGN

Retrospective.

SETTING

University level I trauma center.

PATIENTS

All patients aged 60 and older treated with percutaneous screw fixation for acetabular fractures from 1994 to 2007 were included. Seventy-nine consecutive patients were identified. Thirty-six patients died before functional outcomes were obtained, leaving 43 patients and fractures in our study group. Functional outcomes were obtained in 35 of 43 (81.3%) patients at an average of 6.8 years after the index surgery.

INTERVENTION

Minimally invasive reduction and percutaneous fixation of acetabular fractures.

MAIN OUTCOME MEASUREMENT

Short musculoskeletal functional assessment and Harris Hip Score.

RESULTS

One-year mortality was 13.9% (11 of 79). Average short musculoskeletal functional assessment dysfunction and bother indices were 23.3 and 21.3, respectively, in 24 patients who maintained their native hip. When compared with Short Musculoskeletal Functional Assessment data from 2 other series of patients treated with formal open reduction and internal fixation, no differences existed in the dysfunction (P = 0.49) or bother (P = 0.55) indices. Conversion to total hip arthroplasty occurred in 11 of 36 patients (30.6%). Average Harris Hip Scores in patients with their native hip was 77 (range, 33-100). In the 11 patients converted to total hip arthroplasty, average Short Musculoskeletal Functional Assessment dysfunction and bother indices were 24.3 and 23.9, respectively. No differences were found in the dysfunction (P = 0.93) or bother (P = 0.16) indices when compared with patients converted from open reduction and internal fixation to total hip arthroplasty. Average Harris Hip Score in patients converted to total hip arthroplasty was 83 (range, 68-92), and this was not significantly different from the best scores reported with acute total hip arthroplasty.

CONCLUSIONS

Functional outcomes and rates of conversion to total hip arthroplasty of acetabular fractures in elderly patients treated with percutaneous reduction and fixation show no significant differences when compared with published series of patients treated with formal open reduction and internal fixation.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fracture of the acetabulum: a retrospective review of ninety-one patients treated at a single institution

Acetabular fracture result in fairly good outcome after the anatomic reduction in the displaced fracture fragments and damaged joint structure, but some patients will inevitably suffer from hip joint problems during their courses after the insult. We retrospectively reviewed 91 patients with acetabular fractures to investigate the causes of clinical failure and relationship among the fracture types, selected treatment options and their courses. Ninety-one patients (73 men and 18 women) with an average age of 49 years (range 18-80) at the time of injury were followed up for an average of 8.6 years (range 2-18). Judet-Letournel classification of fracture type and Matta's rating regimen of functional and radiographic patient' assessment were conducted. Conservative treatment was provided in 20 patients, in which 19 attained excellent/good, and one fair clinical results. All achieved excellent/good radiographic outcome. Surgically treated patients (n = 71) with critical dislodgement of the fracture fragment showed that 64 (90%) attained excellent/good and 7 (10%) fair/poor clinical outcomes. Sixty-three (89%) attained excellent/good and 8 (11%) fair/poor postoperative radiographic outcome. Five patients with poor radiographic outcome after surgery subsequently required total hip arthroplasty, due to the development of hip joint osteoarthritis in 3 and femoral head avascular necrosis in 2. We conclude that displacement of the joint surface should be reduced to less than 3 mm in accordance with the selection of the most appropriate surgical approach for open reduction/fixation in each fracture type; however, comminuted fracture and avascular necrosis of the femoral head may be the cause of poor clinical results.

Conservatively treated acetabular fractures: A retrospective analysis

BACKGROUND

There are a few studies reporting the long term outcome of conservatively treated acetabular fractures. The present study aims to evaluate the quality of reduction, and radiological and functional outcome in displaced acetabular fractures treated conservatively.

MATERIALS AND METHODS

Sixty-nine patients (55 men and 14 women) with 71 displaced acetabular fractures (mean age 38.6 years) managed conservatively were retrospectively evaluated. There were 11 posterior wall, 5 posterior column, 6 anterior column, 13 transverse, 2 posterior column with posterior wall, 9 transverse with posterior wall, 6 T-shaped, 1 anterior column with posterior hemi-transverse, and 18 both-column fractures. The follow-up radiographs were graded according to the criteria developed by Matta J. Functional outcome was assessed using Harris hip score and Merle d'Aubigne and Postel score at final followup. Average follow-up was 4.34 years (range 2-11 years).

RESULTS

Patients with congruent reduction (n=45) had good or excellent functional outcome. Radiologic outcome in incongruent reduction (n=26) was good or excellent in 6 and fair or poor in 20 hips. The functional outcome in patients with incongruent reduction was good or excellent in 16 and satisfactory or poor in 10 hips. Good to excellent radiologic and functional outcome was achieved in all patients with posterior wall fractures including four having more than 50% of broken wall. Good to excellent functional outcome was observed in 88.8% of both-column fractures with secondary congruence despite medial subluxation.

CONCLUSIONS

Nonoperative treatment of acetabular fractures can give good radiological and functional outcome in congruent reduction. Posterior wall fractures with a congruous joint without subluxation on computed tomography axial section, posterior column, anterior column, infratectal transverse or T-shaped, and both-column fractures may be managed conservatively. Small osteochondral fragments in the cotyloid fossa or non-weight-bearing part of the hip with a congruous joint do not seem to adversely affect the functional outcome. Displaced transverse fractures with "V" sign may require operative treatment.

Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly

Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed. Patients aged 60 or older treated with percutaneous reduction and fixation of acetabular fractures between 1994 and 2007 were selected. 79 consecutive patients with 80 fractures were identified. Rate of conversion to total hip arthroplasty were used to construct a Kaplan-Meier curve showing survivorship of the native hip joint after treatment. 75 fractures had adequate clinical follow-up with a mean of 3.9 years (range 0.5-11.9 years). Average blood loss was 69 cc and there were no postoperative infections. 19/75 (25%) were converted to total hip arthroplasty at a mean time of 1.4 years after the index procedure. Survivorship analysis demonstrated a cumulative survival of 65% at 11.9 years of follow-up. There were no conversions to arthroplasty beyond 4.7 years postoperatively. There were no statistically significant associations between conversion to arthroplasty and age, sex, closed vs. limited open reduction, and simple vs. complex fracture pattern. Percutaneous fixation is a viable treatment option for patients age 60 or greater with acetabular fractures. Rates of conversion to total hip arthroplasty are comparable to open treatment methods and if conversion is required, soft tissues are preserved for future surgery.

Outcomes of acetabular fracture fixation with ten years' follow-up

We report the outcome of 161 of 257 surgically fixed acetabular fractures. The operations were undertaken between 1989 and 1998 and the patients were followed for a minimum of ten years. Anthropometric data, fracture pattern, time to surgery, associated injuries, surgical approach, complications and outcome were recorded. Modified Merle D'Aubigné score and Matta radiological scoring systems were used as outcome measures. We observed simple fractures in 108 patients (42%) and associated fractures in 149 (58%). The result was excellent in 75 patients (47%), good in 41 (25%), fair in 12 (7%) and poor in 33 (20%). Poor prognostic factors included increasing age, delay to surgery, quality of reduction and some fracture patterns. Complications were common in the medium- to long-term and functional outcome was variable. The gold-standard treatment for displaced acetabular fractures remains open reduction and internal fixation performed in dedicated units by specialist surgeons as soon as possible.