Open reduction and internal fixation for acetabular fractures complicated with injury to lower urinary tract: short-term outcomes / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the short-term outcomes and surgical timing in patients who were treated by open reduction and internal fixation (ORIF) for acetabular fractures complicated with injury to lower urinary tract.Methods A retrospective analysis was conducted of the 14 patients with acetabular fracture complicated with lower urinary tract injury who had been treated at Department of Orthopaedics,The First Affiliated Hospital to Nanjing Medical University from January 2011 to September 2017.They were 12 males and 2 females,with an average age of 40.3 years (from 30 to 56 years).According to Letournel-Judet classification,there were one anterior column,2 transverse,3 anterior column plus posterior hemi-transverse,one T-shaped,5 associated both-column and 2 transverse plus posterior wall fractures.The time from injury to surgery ranged from 6.0 to 30.5 days,with an average of 13.4 days.Of the 8 patients with bladder injury undergoing internal fixation of the acetabulum,a modified ilioinguinal approach combined with a Kocher-Langenbeck approach was used in 4,a single modified ilioinguinal approach in 3,and a Stoppa approach combined with an iliac fossa approach in one;of the 6 patients with urethral rupture undergoing internal fixation of the acetabulum,a modified ilioinguinal approach combined with a Kocher-Langenbeck approach was used in 3,a single modified ilioinguinal approach in one,a Kocher-Langenbeck approach in one and a Stoppa approach in one.The fracture union time,outcomes and complications were recorded.Results The mean follow-up time for the 14 patients was 27.2 months (from 12 to 60 months).The fracture union time ranged from 3.0 to 4.5 months,averaging 3.5 months.According to the Majeed's scoring,the pelvic function at the final follow-up was excellent in 7 patients,good in 4,fair in 2 and poor in one;their scores ranged from 30 to 92 points,averging 80 points.No infection or implant failure occurred during follow-ups.Heterotopic ossification at the acetabulum was observed in one patient whose Brooker grading was Ⅳ at the final follow-up.Conclusion The patients with acetabular fracture complicated with lower urethral or bladder injury should be treated with ORIF as soon as possible so that fine clinical outcomes can be achieved.