Functional Outcome of Surgically Managed Acetabular Fractures

Orthopedics Case Reports

Austin J Clin Case Rep. 2023; 10(4): 1285.

Functional Outcome of Surgically Managed Acetabular Fractures

Muhammad Inam; Imran Khan*; Asif Khan; Muhammad Shabir; Mian Amjad Ali

Department of Orthopedic and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar, Pakistan.

*Corresponding author: Imran Khan Department of Orthopedic and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar, Pakistan. Email: drminamkhan71@gamil.com

Received: May 02, 2023 Accepted: May 27, 2023 Published: June 03, 2023

Abstract

Objective: The objective of study was evaluate the results of open reduction and rigid internal fixation with Reconstruction plates and screws in acetabular fractures.

Material and methods: This prospective case series study was conducted at Orthopedic and Trauma Department of medical Teaching Institute Lady Reading Hospital (LRH) Peshawar Pakistan January 2018 to December 2022 on 21 consecutive patients of either gender with the age range from 18-70 years, having acetabular fracture presenting within one month of injury. Patients with open fracture and trochanteric pin for traction as a treatment modality were excluded from the study. Non-probability consecutive sampling technique was used. Patients were followed for a minimum of 6 months. Clinical grading was done according to D’aubigne and Postel modified by Matta. Pain, gait and range of motion were assessed. Radiological grading was done on last visit according to Matta criteria as excellent good, fair and poor.

Results: There was total 21 patients having age range of 20-60 years with average age of 37.52. Male were 14 (66.7%) while female were 7 (33.3%). The cause of injury was road traffic accident in 13 (61.9%), Fall 6 (28.6%) and Physical Violence in 2 (9.5%) patients. Right side was involved in 13 (61.9%) while left was involved in 8 (38.1%) patients. There was plate loosening in 2 (9.5%) cases. Excellent results were obtained in 11 (52.4%), good in 7 (33.3%), fair in 2 (9.5%) and poor in 1 (4.8%) cases.

Conclusion: Open reduction and internal fixation with 3.5 millimeter reconstruction plate and screws gives Excellent to Good results according to Matta Grading in all fracture of the acetabulam even in osteoporotic bone as well.

Keywords: Acetabulam; Fracture; Internal fixation; Open reduction; Rigid fixation

Introduction

Modernization and industrialization has made more trauma and more road traffic accidents [1]. Trauma can cause multiple injuries to the patients and developed countries has more deaths at the scene of trauma due to high impact [2]. One of the dangerous trauma is the injury to the pelvis which can cause fracture of the acetabulam and if the patient is not resuscitated, s/he may die of blood loss. So management of acetabulam fracture needs priority in trauma patients [3].

Acetabular fracture can occur due to high impact trauma like motor vehicle accident, fall from height or run over injury [4]. Initially such fractures were treated conservatively but with the passage of time and due to complication of conservative management, surgical fixation has been introduced by Judet And Leuternal [5]. They have emphasized on the anatomical reduction and rigid fixation of the fracture which is now the treatment of choice for such fractures. Surgical fixation has led to overall decrease in complication rate like deep venous thrombosis, avascular necrosis of the head of femur and osteoarthritis of hip joint [6].

On the other hand, the operative management of acetabular fracture is a major challenge to an orthopedic surgeon because the complication rate is very high which account to poor results in 20-25 % of patients [7]. Undue delay in management 13 [8], Classification of fracture 14-16 [9], patents' age 17,18 [10], damage to femur head and acetabular cartilage 19,20 [11], hip dislocation 21 [12], vascular or nerve injury and expertise of the surgeon are common factors that can modify final outcome of acetabular fracture [13]. Fixation of acetabular fracture should be done ideally in the first week of injury otherwise results will be poor when fix later than that. We have conducted this study to evaluate the results of open reduction and rigid internal fixation with Reconstruction plates and screws in acetabular fractures.

Materials and Methods

This prospective case series study was conducted at Orthopedic and Trauma Department of medical Teaching Institute Lady Reading Hospital (LRH) Peshawar Pakistan January 2018 to December 2022 on 21 consecutive patients of either gender with the age range from 18-70 years, having acetabular fracture presenting within one month of injury. Patients with open fracture and trochanteric pin for traction as a treatment modality were excluded from the study. Non-probability consecutive sampling technique was used.

Evaluation of the patients were done with standard Radiograph (Pelvis AP and Judet views) and Computerized three dimensional tomogram (3D CT) to know the extent and involvement of the column/wall of the acetabulam and to plan the surgery accordingly. After approval from hospital ethical board, patients fulfilling the inclusion criteria were enrolled from indoor of Orthopedic ward LRH. A written informed consent was taken after explaining the purpose of study. Demographic data including age, gender, and duration of injury was noted. Complete history was taken and physical examination was done. Baseline investigations including CBC, LFT, RFT, serum electrolyte and chest x-ray was done for general anesthesia fitness.

The approaches used for surgery were Kocher-Langenbeck, Ilioinguinal and Triradiate extensile approaches. Trochanteric osteotomy was used in selected cases through posterior approach. The implants used were 3.5mm Reconstruction (Recon) plates and 3.5mm screws. Double Recon plates were used in posterior wall and column fractures. Indirect fixation of anterior column with 4.5mm cortical screw was done along with platting of posterior column in selected cases. Per-op fluoroscopy was used to assess reduction when needed.

Patients were followed for a minimum of 6 months. Clinical grading was done according to D’aubigne and Postel modified by Matta [14]. Pain, gait and range of motion were assessed. Radiological grading was done on last visit according to Matta 14 criteria as: excellent (normal appearing hip joint), good (mild changes with minimal sclerosis and joint narrowing less than 1mm), fair (intermediate changes with moderate sclerosis and joint narrowing less than 50%), and poor (advanced changes). Both the clinical and radiological findings were calculated and the results were summed in Matta Grading [14] (Figure 1).