Surgical revision of malreduced acetabular fractures

Early failure of open reduction and internal fixation of fractures of the acetabulum presents a treatment challenge even more difficult than that of the primary injury. This study evaluates the success of reoperation for 64 patients with surgical malreduction or secondary loss of reduction. In 36 patients (56%) the reconstruction achieved was within 2 mm of being anatomic as judged by plain radiography. Overall, 27 patients (42%) had excellent or good outcomes at an average 4.2 year followup. Delay to reoperation appeared to have an adverse affect on the result of surgery. At followup 57% of patients reoperated on within 3 weeks of injury were rated good or excellent. This figure dropped to 29% when the delay exceeded 12 weeks. These data do not compare favorably with results obtained in large series of singly operated fractures; however, they do indicate that it is possible to salvage a significant number of failed open reductions by reoperation.