Predictor variables in acetabular fractures surgically treated.

INTRODUCTION: Up to 25% of acetabular fractures have poor functional outcomes in short-term follow-up. The aim of our study is to analyze predictors related to poor outcome in surgically treated acetabular fractures. Damage to the femoral head cartilage and poor fracture reduction has been reported as predictors to total hip arthroplasty (THA). MATERIAL AND METHODS: retrospective study of 207 consecutive patients with acetabular fractures, over a fourteen-year period. Demographic data, fracture pattern according to AO/OTA, complications related to surgery and predictor variables were analyzed. RESULTS: Analyzing predictor variables, we observed seagull sign, femoral head dislocation, femoral osteochondral damage, acetabular marginal impaction, poor acetabular roof congruency after surgery (p < 0.001) and postoperative fracture congruence (>3mm) (p < 0.023) statistically related to the need of a THA during follow-up. Age (p = 0,98), Sex(p = 0,27), AO-OTA classification (p = 0,10), type of dislocation (p = 0,25), surgical approach (p = 0,57), time to surgery (p = 0,66) and posterior wall involvement (p = 0,06) were not related to THA. Most frequent complication was nerve injury, affecting 22 patients (20.18%). Only seventeen patients (15.6%) needed a THA at an average time of 6 years after initial open reduction and internal fixation. CONCLUSION: Femoral head damage and dislocation, fracture reduction, and seagull sign were the strongest predictors related to THA after surgical treatment of acetabular fractures.

Correlation between pattern and mechanism of injury of free fall.

To define the pattern of injury and aetiology of death of patients who have sustained major trauma due to high fall and its relationship with the mechanism of free fall. A total of 188 consecutive patients who sustained a high fall were included after the TRAUMASUR database was retrospectively reviewed. Demographic characteristics, severity scores, injury type, aetiology of high fall, mortality rate and aetiology of death were analysed. The mean age was 39.7 years (SD 15.5). The main aetiologies were work related (40.4 %) and suicide attempt (22.3 %). The mean injury severity score (ISS) and New Injury Severity Score (NISS) were 27.3 and 34.1, respectively. The most common cause of mortality within the intentional group was exsanguination (66 %), and the most frequent aetiology of death within the non-intentional group was endocranial hypertension (69 %). Differences were found with regard to the pattern of injuries and the aetiology of death according to the mechanism of free fall.