Functional and radiological results of open reduction and internal fixation of acetabulum fractures

Objective: Assessment of functional and radiological results of patients with acetabulum fracture treated with open reduction and internal fixation was aimed. Material and Methods: The study included 81 patients whom were diagnosed as acetabulum fracture and treated with open reduction and internal fixation between November 2005 – September 2015. All of the cases were followed-up for least one year clinically and radiologically. The fractures were classified according to the Letournel and Judet classification with the assistance of X-ray and computerized tomography (CT) images. Matta's reduction quality criteria was used for the reduction quality postoperatively. Modified Merle D'Aubigne Criteria and Matta's radiological assessment criteria were used for the functional and radiological evaluation respectively at the last follow-up. Results: There were 64 (79%) male and 17 (21%) female patients with a mean age of 42,9 years (range. 17-79 years). The mean follow-up was 51,9 months (range 12-140 months). Fourty-three (53%) of the cases had right and 38 (47%) had left side affected. The mean displacement value was 14,7 mm. The mean surgery time after hospitalization was 6,2 days. According to Letournel classification 44 (54,3%) of the fractures were classified as complex and 37 (45,7%) as simple type. Thirty-two patients had concomitant hip dislocation. Anatomic reduction was obtained in 54 (66,7%) cases and poor reduction in 27 (33,3%) patients. The overall outcome was rated as excellent in 11 (13,6%), good in 31 (38,3%), fair in 12 (14,8%) and poor in 27 (33,3%) clinically. The early complications were superficial infection in 1 patient, deep infection in 1 patient, fixation failure in 2 patients, iatrogenic lateral cutaneous femoral nerve injury in 1 patient, deep vein thrombosis and pulmonary embolism in 1 patient. The late complications were heterotopic ossification in 9 (% 11,1) patients, post traumatic arthrosis in 23 (%28,3) patients and avascular necrosis in 8 (% 9,8) patients. Total hip arthroplasty was applied to 14 patients after open reduction and internal fixation. Conclusions: In this study it was determined that complex fractures, advanced age (>40) and poor reduction quality are correlated with poor prognosis. Anatomic reduction and stable internal fixation are necessary to prevent post-traumatic arthritis and maintain the natural joint functions. Key Words: acetabulum fracture, surgical treatment, fracture fixation, functional results