Evaluation of surgical approach on reduction quality for transverse-family acetabulum fractures

Given the variety of transverse acetabular fracture patterns, different approaches are used for surgical fixation. The purpose of this study is to determine the association between surgical approach and fracture pattern on reduction quality in patients with transverse-family acetabular fractures.

A retrospective review was performed on adult patients with transverse-family acetabular fractures undergoing surgical fixation at a level 1 trauma institution between 2017 and 2023. The primary outcome was reduction quality based on Matta's criteria using postoperative computed tomography (CT) scans and X-rays. On CT scans, the greatest gap displacement and step-off was recorded in all three planes. On X-rays, gap displacement was measured on AP. Secondary outcomes included surgical complications.

On review, 47 patients were included, 68.1% were male with a mean age of 40.1, and an average follow-up of 8 months. Fractures included 12 transverse (approaches: 58.3% anterior, 25% posterior, and 16.7% percutaneous), 26 TP wall (88.4% posterior, 3.8% combined anterior-posterior (AP), and 7.8% percutaneous), and 10 T-shape (approaches: 50% anterior, 20% posterior, 10% combined AP, and 20% percutaneous). Reduction was assessed on postoperative CT with a significant difference in preoperative (6.82 ± 6.64 cm) and postoperative (1.96 ± 1.93 cm) mean maximal displacement (p < 0.001). On CT scans, 19% had anatomic reductions, 65% had good reductions, and 16% had poor reductions. There was no significant difference in CT or X-ray quality reduction between surgical approaches, transverse-family fracture type, hip dislocation on presentation, and surgeon experience, respectively. Patients who were cigarette smokers were more likely to have complications and Matta's grade of '(p = 0.003, = 0.003, respectively).

Although challenging, anatomic and good reductions can be achieved in transverse-family acetabular fractures. There were no observed differences in the quality of reduction or complication rates between different surgical approaches. Approaches for transverse-family acetabular fractures are predicated on careful fracture pattern assessment to determine surgical approach followed by technical execution.