Both-Column Acetabular Fractures: Should Pelvic Ring Reduction or Acetabulum be Performed First?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Skeletal Repair

Background:

• Both-column acetabular fractures (BCAF) present complex challenges due to intricate fracture patterns.
• The choice of reduction landmarks and surgical sequence significantly impacts treatment outcomes.
• Optimizing surgical strategy is crucial for achieving satisfactory reduction and functional recovery.

Purpose of the Study:

• To compare operative metrics, reduction quality, and hip function in BCAF management.
• To evaluate the efficacy of different reduction sequences: pelvic ring fractures reduction first (PRFRF) versus acetabular fractures reduction first (AFRF).

Main Methods:

• A cohort of 42 BCAF patients underwent operative treatment between January 2013 and January 2019.
• Patients were divided into PRFRF (n=22) and AFRF (n=20) groups, with preoperative virtual surgical planning.
• Surgical details, complications, radiographic, and functional outcomes (Matta and Merle d'Aubigné scores) were analyzed.

Main Results:

• The PRFRF group demonstrated superior excellent/good reduction quality (21/22) compared to the AFRF group (17/20).
• PRFRF significantly reduced operative time (152.3 ± 16.3 min) and intraoperative blood loss (639.5 ± 109.9 ml).
• Deep vein thrombosis incidence was lower in the PRFRF group (2/22) versus AFRF (4/20), though not statistically significant.

Conclusions:

• Selecting an appropriate reduction landmark and sequence is vital for BCAF treatment.
• Prioritizing pelvic ring reduction in BCAF surgery leads to better reduction quality, reduced operative time, and decreased blood loss.
• This strategy may improve overall patient outcomes in managing complex acetabular fractures.