Acetabular fractures: operative management and long term results

While the undisplaced acetabular fractures have a good prognosis after conservative treatment, the management of the displaced fractures has been a controversial issue over the last decades with variable results in their treatment and prognosis. Anatomical reduction can be only achieved operatively. The long term outcome of 209 patients with displaced acetabular fractures treated by open reduction and internal fixation was presented.

Between 1972 and 1996, 209 patients with a mean age of 38 years (15-62a) were treated for displaced acetabular fractures operatively. 161 patients could be followed up over a period of 2 to 20 years. The function of the hip joint in correlation with radiological results was evaluated according to the scheme of Merle d'Aubinge.

Patients with single column fractures showed 90% good or excellent results followed by 55% good or excellent results in patients with transverse fractures. The highest rates of complication (20% osteoarthritis, 6% femoral head necrosis, 9% heterotopic ossification) were observed in both column fractures and in transverse and posterior wall fractures. Deep infection was observed in 6 cases (4%), superficial wound infection in 8 cases (5%). Primary sciatic nerve palsy was seen in 10 cases (6%) and postoperative peroneal nerve palsy in 6 cases (4%), all of which improved during the rehabilitation period.

Displaced acetabular fractures of the weight bearing part of the dome, i.e. transtectal fractures, should be treated operatively. The operation should preferably be performed within one week after the injury.