Operative management of displaced acetabular fractures: an institutional experience with a midterm follow-up.

BACKGROUND: Operative management is considered to be the treatment of choice in acetabular fractures as this is the unique way of achieving precise anatomical reduction, stable internal fixation, and early mobilization of joint. With this background in mind we undertook a prospective study with an aim to assess the outcome of surgery in displaced acetabular fractures at our general orthopedic centre as a first experience. MATERIAL AND METHODS: This study was conducted on 59 patients (45 Males, 14 Females ) with mean age of 38.35 years (range 18-60 years) with displaced acetabular fractures who were admitted consecutively at our centre from May 2008 through November 2011. Nine patients (7 Male, 2 Female) were lost during follow up. The average follow up was 3.5 years (range 2-5 years). Prophylaxis for deep venous thrombosis and heterotopic ossification was used routinely in all patients. RESULTS: Clinical evaluation was based on modified Merle-d'Aubigne and Postel scoring system. Radiological evaluation was done according to criteria developed by Matta. It was graded as excellent in 16% hips, good in 54% hips, fair in 20% hips and poor in 10% hips. Good to excellent results were achieved in 42 cases (70%). The complications included were implant backout, postoperative dislocation, iatrogenic nerve palsy, superficial wound infection, intraoperative bleeding and osteoarthritis. There is a positive relationship between quality of reduction and functional outcome. In our series, radiographic congruity (75%) correlated well with the function (70%). CONCLUSIONS: 1. We conclude that operative treatment is a safe and effective method of managing displaced acetabular fractures even in general orthopedic centres. 2. Time spent on a thorough study of the radiographs/CT scan for a proper preoperative plan is worthwhile and helps to outline an appropriate surgical approach and avoid complications.

Midterm functional outcome after operative management of midfoot injuries.

Background. Injuries of the midfoot are often missed and therefore underestimated. Early diagnosis and treatment are crucial for the final outcome. The primary aim of this study was to assess the pattern and results of early operative management of mid-foot injuries after a midterm follow up. Material and methods. This study was conducted on 25 patients (19 Males, 6 Females ) with mean age of 34.6 years (range 18-60 years) with mid-foot fracture dislocations who were admitted consecutively at our centre from May 2008 through November 2010. 25 patients fulfilling our inclusion criteria with mid-foot fracture dislocations were included in this study. Mechanism of injury, its pattern and results of operative management of midfoot injuries were assessed after acute management of these fractures on urgent basis. Evaluation of results was done by AOFAS Score. Results. Most common mode of injury was indirect trauma due to fall (n=12) followed by road traffic accident (n=9). Males (n=19) outnumbered females (n=6). The pattern of injuries requiring operative treatment as per our criteria were Lisfranc fracture dislocations (n=22) and navicular fractures (n=3). The mean follow up was 3.2 years and mean AOFAS score at 3.2 years was 78.36, with most patients losing points to pain and decreased recreational function. Conclusion. The Lisfranc fracture dislocations are the most common injuries around midfoot requiring operative treatment, and we believe that operative treatment considerably improves functional outcome in these injuries.