From fracture to function: return-to-sport after acetabular fractures

Acetabular fractures can affect young, athletically active patients. This study aimed to describe the previously unexplored interaction between injury severity, return to sport, and subjective attitude towards sport.

Twenty-two patients with acetabular fracture treated at a Level I Trauma Center between Jan. 2009-Dec. 2020 were retrospectively included. Patients received a postal questionnaire assessing activity level and sporting activity before trauma (PRE) and after trauma (POST). The median follow-up was 145 (IQR 75.5-166) months. Patients also reported whether the injury altered their subjective attitude towards exercise.

Participants were divided into two subgroups according to ISS: ISS <16 = 'no polytrauma' (n = 8) and ISS ≥16 = 'polytrauma' (n = 14). The mean highest UCLA Activity Score decreased more in the 'no polytrauma' subgroup (-39.7 %) than in the 'polytrauma' subgroup (-23.4 %). The POST sports break lasted over five times longer in the 'polytrauma' subgroup, who more often underwent longer inpatient rehabilitation. In the 'no polytrauma' subgroup, 50 % (3/6) of previously active athletes returned to sport, whereas all PRE active patients in the 'polytrauma' subgroup returned (10/10). POST sport level was lower in the 'no polytrauma' subgroup (0 % club sports (0/8), 37.5 % occasional (3/8); 0 % high-impact (0/8), 37.5 % low-impact (3/8)) compared with the 'polytrauma' subgroup (21.4 % club sports (3/14), 50 % occasional (7/14); 35.7 % high-impact (5/14), 35.7 % low-impact (3/8)). A negative change in the subjective attitude towards exercise occurred in 12.5 % (1/8) of 'no polytrauma' patients and 42.9 % (6/14) of 'polytrauma' patients.

Sporting activity was reduced after acetabular fracture. Although 'polytrauma' participants reported more negative shifts in exercise attitude, they demonstrated higher return-to-sport rates compared with 'non-polytrauma' participants. Potentially the longer sport interruption and inpatient rehabilitation may facilitate more effective reintegration. Further studies with larger study groups are warranted.