ABSTRACT
Over a five-year period, adult patients with marginal impaction of acetabular fractures were identified from a registry of patients who underwent acetabular reconstruction in two tertiary referral centres. Fractures were classified according to the system of Judet and Letournel. A topographic classification to describe the extent of articular impaction was used, dividing the joint surface into superior, middle and inferior thirds. Demographic information, hospitalisation and surgery-related complications, functional (EuroQol 5-D) and radiological outcome according to Matta's criteria were recorded and analysed. In all, 60 patients (57 men, three women) with a mean age of 41 years (18 to 72) were available at a mean follow-up of 48 months (24 to 206). The quality of the reduction was 'anatomical' in 44 hips (73.3%) and 'imperfect' in 16 (26.7%). The originally achieved anatomical reduction was lost in12 patients (25.8%). Radiologically, 33 hips (55%) were graded as 'excellent', 11 (18.3%) as 'good', one (1.7%) as 'fair' and 15 (25%) as 'poor'. A total of 11 further operations were required in 11 cases, of which six were total hip replacements. Univariate linear regression analysis of the functional outcome showed that factors associated with worse pain were increasing age and an inferior location of the impaction. Elevation of the articular impaction leads to joint preservation with satisfactory overall medium-term functional results, but secondary collapse is likely to occur in some patients.
Subject(s)
Acetabulum/injuries , Acetabulum/surgery , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Acetabulum/diagnostic imaging , Adolescent , Adult , Aged , Female , Follow-Up Studies , Hip Fractures/diagnostic imaging , Humans , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Young AdultABSTRACT
Fracture stabilisation before the 19th century was in its infancy. The outcome was suboptimal, and quite often mortality was the end result. Advances in the stabilisation of long-bone fractures did not become apparent until the mid-1940s and for other bones, even later. In the mid-1960s, Judet and Letournel initiated a series of experimental and clinical studies focusing on pelvic and acetabular reconstruction surgery. Their work set the pace for all the subsequent advancements made in this field of surgery. Today, pelvic and acetabular reconstruction is a recognised subspecialty within the disciplines of trauma and orthopaedics. This review article traces the evolution of pelvic and acetabular surgery, from ancient to modern times.
