| Background and Purpose: Acetabular fractures are rapidly increasing in the present scenario of the practice of orthopedic surgery due to ever increasing high velocity injuries especially the road traffic accidents (RTAs). Rapid increase in the incidence of acetabular fractures and high expectations of the patients has compelled the orthopaedic surgeons across the world to do more research and study this particular fracture. Most of the improvements in the classification systems and treatment modalities have occurred in the past three decades. Still then many important matters remain to be solved, including decision making (i.e. whether to operate), the details of surgical technique and the avoidance of complications. Major problems in the acetabulum are complicated anatomy, making exposure of the fracture difficult and severe comminution of the fracture, making reduction and fixation difficult. Anatomical restoration of the dome with concentric reduction of the femoral head beneath the dome is the goal of both operative and non-operative treatments. The quality of acetabular fracture reduction is the single most important factor in he long term outcome of the patient. The purpose of this study is to evaluate the functional outcome of the surgically treated acetabular fractures and its associated complicationsObjectives: To explore the correlative factors influencing the operative results of acetabular fractures.Methods: Thirty three patients with displaced acetabular fractures treated by open reduction and internal fixation admitted from January 2002 to January 2007 were reviewed which included 27 males and 6 females with mean age of 40.8 years (range, 21-69 years). According to Letournel and Judet classification 8 were posterior wall fractures, 2 anterior wall, 5 anterior column, 4 posterior column and posterior wall, 5 transverse and posterior wall, 7 T shaped fractures, and 2 both column fractures. Ilio-inguinal approach were applied for 7 cases, Kocher-Langenbeck in 12, combined approach in 12, Wang Gang approach in 1 and modified extended ilio-femoral approach designed by our team in 1 case.Result: The average follow-up was 14 months (range 3 months to 3 years). Motor vehicle accidents were the predominant cause for acetabular trauma (17/33). Seven patients were injured by heavy weight and another 9 patient had a fall from a height. Twenty-four percent (8/33) of our patients with displaced acetabular fractures had associated injures. There was head injury in one patient, spine fracture in 2 patients, sciatic nerve injury in 3 patients and chest injury in 2 patients. The results were evaluated according to Functional Outcome Scoring System by Matta and Standard radiographic assessment of Matta. According to Matta's scoring system 7 were excellent, 18 good, 4 fair and 4 had poor results. The good to excellent results were achieved in 75.8% of the cases. Based on post-operative radiological evaluation, 22 were excellent, 6 good, 3 fair and 2 had poor outcome. The good to excellent result were achieved in 84.8% of the cases. There was one case of superficial infection, 3 cases of avascular necrosis of femoral head, 3 cases of heterotopic ossification, 1 case of sciatic nerve injury, 1 case of malunion and 12 cases of post traumatic osteoarthritis. However, there was no case of non union. Conclusions:Selection of the appropriate approach is very essential in the functional outcome and this selection depends upon the classification of the fracture, associated complications, the experience of the surgeon and whether the reduction is difficult or not. The spiral CT and 3 D reconstruction images are the essential tools for diagnosis of the fracture type and planning of the surgery. The approach designed in this series is easy to expose, reduce and fix the fracture but this approach is applicable only in old fractures and those fractures that are difficult to reduce. |
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