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Permissive Weight-Bearing after Fixation of Displaced Acetabular Fractures: A Case Series Study
Indy Smits1, Bas Frietman2, Niek Koenders1
1Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands.
Backgroud:
The primary treatment option for displaced acetabular fractures is open reduction and internal fixation, aiming to restore joint congruency and prevent secondary osteoarthritis. Historically, postoperative rehabilitation consists of 6 to 12 weeks of non-weight-bearing. This study was conducted to examine the functional and safety outcomes of permissive weight-bearing after operative treatment of displaced acetabular fractures.
Methods:
This prospective, single-center case series study included the first 10 patients who underwent surgery in a European level I trauma center and followed a permissive weight-bearing protocol for loading the affected leg. Patients with relevant concomitant injuries (e.g., fractures that might impede rehabilitation) were excluded. Functional outcome was scored using the Hip Disability and Osteoarthritis Outcome Score and the modified Merle d'Aubigné and Postel score. A low-dose computed tomography was performed to detect fracture displacement.
Results:
Ten patients were included. The median Hip Disability and Osteoarthritis Outcome Score was 99.7 (interquartile range [IQR], 87.5-100) preoperatively, 18 (IQR, 15-37.5) on days 1 to 3, 38.9 (IQR, 35-53.8) at week 1, 42.2 (IQR, 36.4-54.4) at week 3, 54.1 (IQR, 32.5-64.4) at week 6, and 65 (IQR, 43.8-79.4) at week 12. The median modified Merle d'Aubigné and Postel score was 11.5 (IQR, 9-13.5) at week 1, 14 (IQR, 11-15.5) at week 3, 14 (IQR, 11.5-15.5) at week 6, and 17 (IQR, 14.5-17.5) at week 12. The average preoperative displacement was 12 mm. Secondary displacement occurred in 3 of 10 patients.
Conclusions:
Functional outcomes at 12 weeks were promising, and permissive weight-bearing appeared sufficiently safe in patients without impaction or involvement of the acetabular dome after surgical fixation of a displaced acetabulum fracture.
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