Original scientific paper

https://doi.org/10.20471/acc.2023.62.01.19

Outcomes of Surgical Treatment for Displaced Both-Column Acetabular Fractures

Nikola Bulatović ; Department of Orthopedic Surgery and Traumatology, Clinical Center of Montenegro, Podgorica, Montenegro; Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
Nadomir Gusić ; Department of Orthopedic Surgery and Traumatology, Pula General Hospital, Pula, Croatia
Tomislav Čengić ; Department of Orthopedic Surgery and Traumatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

Abstract

Complex both-column acetabulum fractures are severe injuries, often with associated
injuries and complications with uncertain clinical and functional outcome. Modern traumatological
protocols point to early surgical treatment, with anatomical reduction and stable internal fixation of fragments
as a prerequisite for achieving a good treatment outcome. This retrospective-prospective multicenter
cohort study was conducted during the 2014-2020 period and included 24 cases that met the input
parameters, using the Letournel and Judet classification, and application of a combined surgical approach,
a modified Stoppa and Kocher-Langenbeck approach. The results of treatment with complications, associated
injuries and functional outcome are described. Fractures were caused by high kinetic energy trauma,
and the cause was traffic accident in 17/24 (70.84%), fall from a height in 5/24 (20.83%) and crash
injuries in 2/24 (8.33%) cases. The sample included 18 (75.00%) male and 6 (25.00%) female, with 10/24
(41.67%) right sided and 14/24 (58.33%) left sided fractures. Their mean age was 45.06 (range, 24-62)
years. The mean follow-up time was 2.8 (range, 1-5) years. Postoperative complications were detected in
14/24 (58.33%) cases, including wound infection in 4/24 (16.67%), deep vein thrombosis in 2/24 (8.33%),
heterotopic ossification in 2/24 (8.33%), hip osteoarthrosis in 3/24 (12.50%), avascular necrosis of femoral
head in 2/24 (8.33%), total hip arthroplasty procedures in 3/24 (12.50%), abdominal complications
in 2/24 (8.33%), urologic complications in 2/24 (8.33%), iatrogenic nerve lesion in 3/24 (12.50%), and
fatal pulmonary embolism in 2/24 (8.33%) cases; there was no loss of reduction or non-union acetabular
fracture. Associated injuries that we recorded as major trauma were presented in 13/24 (54.17%) study
patients. The final functional results according to the Harris Hip Score (HHS) were excellent in 7/22
(31.82%), good in 10/22 (45.45%), moderate in 4/22 (18.18%) patients, and poor in 1/22 (4.55%) patient.
The mean HHS was 84 (range 34-98). Complications and results have led us to a conclusion that primary
injuries significantly affect the clinical and functional results. A good diagnostic procedure, assessment of
the general condition and application of the trauma scoring system, surgical treatment that includes early
hip reduction, open reduction internal fixation and physical rehabilitation are necessary.

Keywords

Both-column acetabulum fractures; Complications; Internal fracture fixation

Hrčak ID:

307276

URI

https://hrcak.srce.hr/307276

Publication date:

1.4.2023.

Article data in other languages: croatian

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