[Acetabular fractures: short-term results]. / Fracturas de acetábulo. Resultados a corto plazo.

OBJECTIVE: To evaluate the results of surgical treatment of displaced acetabular fractures, and to discern which variables influence the final radiological and clinical outcome. METHODS: We retrospectively analyzed 23 patients who underwent open reduction and internal fixation of acetabular fracture with a mean age of 40.4 years (17-72 years). Mean follow-up was 4 years (1.5-7.5 years). According to Judet and Letournel classification, we operated 10 simple fractures (43.5%) and 13 complex (56.5%), with both-column fractures being the most common type (8 hips). We evaluated the quality of reduction achieved, the clinical results and the occurrence of coxarthrosis. RESULTS: We obtained anatomic reduction of the lesion in 12 cases (52%), in 7 (30%) residual displacement was less than 2mm, and in 4 patients (17%) greater than 2mm. According to Harris' score, the clinical outcome was excellent or good in 18 cases (78%) and fair or poor in 5 (22%), getting worse in complex fractures and when we do not reach an anatomic reduction of the injury. Six patients (26%) developed moderate or severe degenerative changes during follow-up. The degree of postoperative reduction obtained was identified as the main predictor of the development of post-traumatic osteoarthritis. DISCUSSION AND CONCLUSIONS: The acquisition by open reduction and internal fixation of an accurate congruence between the femoral head and acetabulum is essential to achieve good long-term results.

Fracturas de acetábulo. Resultados a corto plazo / Acetabular fractures: short-term results

Objetivo. Evaluar los resultados del tratamiento quirúrgico de las fracturas desplazadas de acetábulo. Discernir que variables influyen en el resultado clínico y radiológico final. Material y métodos. Analizamos de forma retrospectiva 23 pacientes intervenidos de fractura acetabular mediante reducción abierta y fijación interna, con una edad media de 40,4 años (17-72 años). El seguimiento medio fue de 4 años (1,5-7,5 años). Según la clasificación de Judet y Letournel intervinimos 10 fracturas simples (43,5%) y 13 complejas (56,5%), siendo la fractura de ambas columnas la más frecuente (8 casos). Valoramos la calidad de la reducción obtenida, los resultados clínicos y la aparición de coxartrosis. Resultados. Obtuvimos una reducción anatómica de la lesión en 12 casos (52%), en 7 (30%) el desplazamiento residual fue menor de 2mm y en 4 pacientes (17%) mayor de 2mm. Según la escala de Harris, el resultado clínico fue excelente o bueno en 18 casos (78%) y aceptable o pobre en 5 (22%), obteniendo peores resultados en fracturas complejas y cuando no alcanzamos una reducción anatómica de la lesión. Seis pacientes (26%) habían desarrollado cambios degenerativos moderados o severos al final del seguimiento. El grado de reducción postquirúrgica obtenida fue identificado como el principal predictor de desarrollo de coxartrosis postraumática. Discusión y conclusiones. La obtención mediante reducción abierta y fijación interna de una correcta congruencia entre la cabeza femoral y el acetábulo es esencial para lograr buenos resultados a largo plazo (AU)

Objective. To evaluate the results of surgical treatment of displaced acetabular fractures, and to discern which variables influence the final radiological and clinical outcome. Methods. We retrospectively analyzed 23 patients who underwent open reduction and internal fixation of acetabular fracture with a mean age of 40.4 years (17-72 years). Mean follow-up was 4 years (1.5-7.5 years). According to Judet and Letournel classification, we operated 10 simple fractures (43.5%) and 13 complex (56.5%), with both-column fractures being the most common type (8 hips). We evaluated the quality of reduction achieved, the clinical results and the occurrence of coxarthrosis. Results. We obtained anatomic reduction of the lesion in 12 cases (52%), in 7 (30%) residual displacement was less than 2mm, and in 4 patients (17%) greater than 2mm. According to Harris’ score, the clinical outcome was excellent or good in 18 cases (78%) and fair or poor in 5 (22%), getting worse in complex fractures and when we do not reach an anatomic reduction of the injury. Six patients (26%) developed moderate or severe degenerative changes during follow-up. The degree of postoperative reduction obtained was identified as the main predictor of the development of post-traumatic osteoarthritis. Discussion and conclusions. The acquisition by open reduction and internal fixation of an accurate congruence between the femoral head and acetabulum is essential to achieve good long-term results (AU)