Characteristics and treatment of acetabular fracture combined with ipsilateral femoral neck fracture / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the injury characteristics, treatment strategy and prognosis of acetabular fracture combined with ipsilateral femoral neck fracture.Methods:A retrospective analysis was conducted of the 15 patients with acetabular fracture combined with ipsilateral femoral neck fracture who had been treated from January 2009 to June 2021 at Department of Orthopaedics, The First Hospital Affiliated to Nanjing Medical University. They were 10 males and 5 females, aged from 26 to 68 years (average, 47.1 years). The treatment strategy depended on their injury characteristics. For the 3 patients with incomplete displacement of the femoral neck fracture but no hip dislocation, the femoral neck fracture was treated by closed reduction and internal fixation; for the 7 patients with complete displacement of the femoral neck fracture but no hip dislocation, the femoral neck fracture was treated first by closed reduction and then by open reduction and internal fixation in case the closed reduction had failed; for the 5 patients complicated with hip dislocation (anterior one in 2 cases and posterior one in 3 cases), the femoral neck fracture was treated by open reduction and internal fixation. The acetabular fractures were treated via an appropriate surgical approach depending on their classifications. The operation time, intraoperative bleeding, fracture healing, functional recovery and complications such as postoperative avascular necrosis of the femoral head (NFH) were recorded.Results:In this cohort, the operation time ranged from 170 to 540 min, averaging 210 min, and the amount of intraoperative bleeding from 300 to 7,900 mL, averaging 800 mL. Postoperative X-ray films showed that all acetabular fractures and femoral neck fractures achieved anatomical reduction or satisfactory reduction. All patients were followed up for 1 to 13 years (average, 4 years). One patient had to receive total hip arthroplasty due to nonunion one year after operation, and the fractures in the other 14 patients healed by the first intention. At the last follow-up by the Merle d'Aubigné & Postel scoring, the function of the hip affected was excellent in 3 cases, good in 6 and poor in 6. NFH occurred in 4 cases, of which one had no hip dislocation and 3 had hip dislocation. Ectopic ossification developed in one patient after operation.Conclusions:The incidence of NFH is high in the patients with acetabular fracture combined with ipsilateral femoral neck fracture, especially higher in those complicated with hip dislocation. Treatment strategies should vary according to the injury characteristics. Attention should be paid to protection of the blood supply to the femoral head which significantly improves the prognosis.