Operative treatment of displaced fractures of the acetabulum

TLDR

Displaced acetabular fractures have shifted from conservative to operative management over the past 40 years, yet remain challenging to treat. This meta‑analysis evaluates classification, complication incidence, and functional outcomes after operative treatment of displaced acetabular fractures. The authors pooled data from 3,670 fractures across studies. Long‑term osteoarthritis occurred in about 20 % of patients, while heterotopic ossification and avascular necrosis were seen in less than 10 %; only 8 % required a second operation, and 75–80 % achieved excellent or good results at a mean of five years, with functional outcome influenced by fracture type, femoral head damage, comorbidities, timing, surgical approach, reduction quality, and local complications.

Abstract

Over the past 40 years, the management of displaced fractures of the acetabulum has changed from conservative to operative. We have undertaken a meta-analysis to evaluate the classification, the incidence of complications and the functional outcome of patients who had undergone operative treatment of such injuries. We analysed a total of 3670 fractures. The most common long-term complication was osteoarthritis which occurred in approximately 20% of the patients. Other late complications, including heterotopic ossification and avascular necrosis of the femoral head, were present in less than 10%. However, only 8% of patients who were treated surgically needed a further operation, usually a hip arthroplasty, and between 75% and 80% of patients gained an excellent or good result at a mean of five years after injury. Factors influencing the functional outcome included the type of fracture and/or dislocation, damage to the femoral head, associated injuries and co-morbidity which can be considered to be non-controllable, and the timing of the operation, the surgical approach, the quality of reduction and local complications which are all controllable. The treatment of these injuries is challenging. Tertiary referrals need to be undertaken as early as possible, since the timing of surgery is of the utmost importance. It is important, at operation, to obtain the most accurate reduction of the fracture which is possible, with a minimal surgical approach, as both are related to improved outcome.