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Acetabular fracture displacement, roof arc angles and 2 years outcome
Stein Øvre1, Jan Erik Madsen, Olav Røise
1Ullevål University Hospital, Oslo, Norway. SteinA.Ovre@ulleval.no
Insights
Acetabular fracture location in the acetabular dome, measured by Roof Arc Score, significantly impacts 2-year clinical outcomes. Perfect anatomical reduction via open reduction and internal fixation (ORIF) negates this impact.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Radiology
Background:
- Acetabular fractures are complex injuries requiring careful management.
- Assessing fracture displacement and dome involvement is crucial for predicting outcomes.
Purpose of the Study:
- To correlate acetabular fracture characteristics with 2-year clinical outcomes.
- To evaluate the significance of fracture line location versus residual displacement.
Main Methods:
- Prospective cohort study of 176 patients with acetabular fractures.
- Utilized Harris Hip Score (HHS) and modified HHS for outcome assessment.
- Assessed fracture displacement and roof arc angles (Roof Arc Score) radiographically.
Main Results:
- Fracture line location in the acetabular dome (Roof Arc Score) was more critical than residual steps for 2-year outcomes (p<0.05).
- Open reduction and internal fixation (ORIF) achieving perfect anatomical reduction eliminated the impact of fracture line location.
- Poor correlation between fracture diastases and functional outcome, except in non-operatively treated fractures without steps.
Conclusions:
- Acetabular dome involvement is a key predictor of functional outcome after acetabular fractures.
- Achieving anatomical reduction with ORIF is paramount to mitigate negative prognostic factors.
- Radiographic assessment of fracture patterns aids in predicting long-term functional recovery.
Abstract:
Four hundred and fifty acetabular fractures in a prospectively recorded cohort were studied. Forty-one patients had died, 201 had a follow-up of more than 2 years and 25 were excluded which left a study population of 176 patients. Harris Hip Score (HHS) and modified HHS were used as outcome instruments. Acetabular fracture displacement and roof arc angles converted into a Roof Arc Score were assessed and correlated with clinical outcome at 2 years follow-up. For surgically treated fractures with residual steps and diastases after operation the correlation between steps and 2 year outcome was good. The location of fracture lines in the acetabular dome, expressed as a Roof Arc Score, proved to be more important than the residual step for 2 years clinical outcome (p<0.05). The impact of location of fracture lines in the acetabular dome on clinical outcome disappeared when open reduction and internal fixation (ORIF) resulted in a perfect anatomic reduction, i.e. without any residual steps or diastases assessed in the three radiographic views. The general association between fracture diastases and functional outcome was poor, except for non-operatively treated fractures without measurable steps.
