Analyze The Risk Of Poor Prognosis After Acetabular Posterior Wall Fracture

Objective: Acetabular posterior wall fracture is the most common type of acetabulum fracture. Acetabular posterior wall is important and weak anatomic structure which can maintain the stability of hip,and it is always under stress, therefore it is better to get anatomical reduction and firm internal fixation after fracture.If treatment failure occurred dysfunction of hip take place.Some scholars refer that though the therapy of acetabular posterior wall fracture is simple but the prognosis is poor,case who have no satisfactory effect account for 30%.This article analysis the risk factor of poor prognosis and group the cases according to the risk factor and definite the relationship between poor prognosis and risk factor.Hope to help improving the curative effect of acetabular posterior wall fracture.Methods:We collect 50 cases of acetabular posterior wall fracture of our hospital from 2006 to 2010,there are 18 cases traumatic arthritis or femoral head osteonecrosis cases who have replacement of total hip.We group the cases according the fracture,male 31 cases and female 19 cases; more than 45 years 33 cases and less than 45 years 17 cases; non-operative therapy 8 cases,surgical treatment 42 cases; screw internal fixation 12 cases,pelvic plate internal fixation 30 cases;anatomical reduction 32 cases,satisfactory restoration 18 cases;medical history of femoral head necrosis 6 cases; time of femoral dislocation>12h 12 cases; time of injury >10d 11 cases and <10d 39 cases; femoral head dislocation 36 cases and no dislocation 14 cases, we sudy the cases by retrospective analysis and definite the relationship between poor prognosis and risk factor byχ2 test,χ2 >3.84 than P<0.05 orχ2 >6.63 than P<0.01,this is significant difference.Results:All the cases are grouped by risk fractors of poor prognosis:1.Age: more than 45 years 33 cases and less than 45 years 17cases, 16 poor prognosis cases are in the first group and 2 poor prognosis cases are in the second. 2. Therapeutic method: non-operative therapy 8 cases including 6 poor prognosis cases,surgical treatment 42 cases including 12 poor prognosis cases. 3. Internal fixation: screw internal fixation 12 cases including 5 poor prognosis cases,pelvic plate internal fixation 30 cases including 13 poor prognosis cases. 4. Reduction of fracture: anatomical reduction 32 cases including 5 poor prognosis cases,satisfactory restoration 18 cases including 13 poor prognosis cases. 5.Medical history of femoral head necrosis: the 6 cases who have femoral head necrosis all have poor prognosis,the others have 12 poor prognosis cases. 6.Time of femoral dislocation: >12h cases including 8 poor prognosis cases,<12h cases including 7 poor prognosis cases. 7. Injury date: >10d 11 cases including 10 poor prognosis cases and <10d 39 cases including 8 poor prognosis cases. 8. Femoral head dislocation: dislocation 36 cases including 16 poor prognosis cases and no-dislocation 14 including 2 poor prognosis cases. Statistical analysis results: every grouped cases take place significant difference byχ2 test.Conclusions: Age, therapeutic method, type of internal fixation, status of fracture reduction, medical history of femoral head necrosis, time of femoral dislocation, injury date and femoral head dislocation are related to the prognosis of acetabular posterior wall fracture and influence the prognosis of acetabular posterior wall fracture. However, for the number of cases is limted we can not determine the conclusion is universal and we need more clinical cases to support the conclusion. The poor prognosis of acetabular posterior wall fracture can not be formed by one factor, evry case contains several risk elements. To analyse one element is not comprehensive and aggregate analysis is not specific, thus the study of acetabular posterior wall fracture should be reached profoundly and chronically.