Indicators of outcome after internal fixation of complex acetabular fractures

Complex acetabular fractures are not uncommon injuries in Egypt. The aim of surgical treatment is to preserve hip mobility and to avoid post-traumatic arthritis. The aim of this study was to evaluate the clinical results of patients presented by displaced complex acetabular fractures and treated by open reduction and internal fixation. Factors affecting these results were to be determined. Displaced acetabular fractures involving the both columns were included. Initial assessment and treatment were directed towards the patient's general condition. Posterior hip dislocation was reduced as fast as possible. Standard X-ray views and CT cuts were done for every patient. The definite surgery was done through an ilio-inguinal, a Kocher-Langenbeck or combined approaches. Postoperatively, the residual displacement was recorded together with the head roof relationship. Using Matta radiological and modified clinical grading, a correlation between radiological and clinical results was made. Factors affecting the outcome were defined. The study involved 55 patients between May 2007 and December 2010. The mean follow-up period was 29.62 +/- 7.19 months with a minimum of 12 months and a maximum of 43 months. Excellent to good results were achieved in 38 cases, 69.1%, while fair to poor results were obtained in 17 cases, 30.9%. Anatomical reduction and/or restoration of perfect head/roof congruency were strongly associated with better outcome. Beside this there was significant relation between good clinical outcome and the utilisation of the anterior approach. On the other hand bad outcome was associated with these factors: [1] associated pelvic ring injury, [2] fracture of the posterior wall, [3] articular surface comminution and [4] the presence of intra-articular fragments. Fracture personality and not the fracture type is the main determinant of its complexity. Surgical experience is required to achieve the best reduction while avoiding complications