Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction

Sang-Hong Lee; Min-Kyu Shin; Sueng-Hwan Jo

doi:10.4055/jkoa.2007.42.2.153

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Lee, Shin, and Jo: Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(2): 153-161.

Published online: 30 April 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.2.153

Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction

Sang-Hong Lee, M.D., Min-Kyu Shin, M.D., Sueng-Hwan Jo, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to Sang-Hong Lee,M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 588, Seoseok-dong, Dong-gu, Gwangju 501-717, Korea. Tel: + 82.62-220-3147, Fax: + 82.62-226-3379, shalee@chosun.ac.kr

Abstract

Purpose

To analyze postoperative clinical and radiological results of displaced acetabular fractures and to determine the factors affecting the clinical results.

Materials and Methods

Clinical analysis was performed on 51 patients with displaced acetabular fractures who had been operated on and followed up for a minimum of 1 year. The mean follow-up duration after surgery was 45 months (range, 12 to 67 months). The outcome was analyzed clinically using Postel's clinical grade criteria and radiologically using Mattas roentgenographic grading system.

Results

There was a statistical relationship between the type of fracture patterns (Letournel classification) and the degree of immediate postoperative reduction (p<0.05). A comparison of the radiological and clinical results at the last follow-up revealed a good correlation between good or excellent radiology results and good or excellent clinical results (p<0.05). The factors affecting the clinical outcomes of the last follow-up were the type of fracture (Letournel classification), the presence or absence of a femoral head injury and the degree of immediate postoperative reduction.

Conclusion

The results of this study suggest that the degree of reduction was closely related to the clinical result. Therefore, it is important in the surgical treatment of the acetabular fractures to classify the fractures accurately, reduce the fragments anatomically and minimize the complications.

Keywords: Acetabular fracture, Operative treatment, Anatomical reduction

Figures and Tables

Fig. 1

A 39-year-old female. Preoperative pelvis anteroposterior (AP) radiograph (A) and 3D computed tomography (B) demonstrate a posterior wall fracture. Radiograph obtained 14 months after surgery demonstrate excellent clinical and radiological results.

Fig. 2

A38-year-old female. Preoperative pelvic AP radiograph(A)and 3Dcomputed tomography(B)demonstrate bothcolumnfractures. Postoperative pelvis AP radiograph (C) demonstrates an imperfect reduction and secure fixation through the ilioinguinal approach. Radiograph (D) and CT scan (E, F) obtained 39 months after surgery demonstrate good results.

Fig. 3

A 41-year-old male. Preoperative pelvis AP radiograph( A)and 3Dcomputed tomography (B) demonstrates a transeverse fracture. Postoperative pelvis AP radiograph (C) demonstrates poor reduction through the Kocher-Langenbeck approach. Radiograph (D) obtained 17 months postoperatively demonstrate poor results.

Fig. 4

"Roof arc" measurement, as described by Matta et al. (A) The medial roof arc was measured on anteroposterior view. (B) The anteriorroof arc was measured ona 45-degree angle obturator oblique view. (C)The posteriorroof arc was measured ona 45-degree angle iliac oblique view.

Table 1

Fracture Classification (Letournel)

Table 2

Radiology Results

Table 3

Distribution of the Clinical Grades Within Each Initial Reduction State

Table 4

Distribution of the Clinical Grades Within Each Radiological Result

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