Aim To investigate the effects of surgical reduction of complex acetabular fractures on spine balance, postural stability and quality of life. Methods Twenty-six patients with acetabular fractures surgically treated by open reduction and internal fixation were divided into two groups according to the amount of reduction. Group A consisted of 18 patients with satisfactory reduction (≤2 mm), and group B of eight patients with incomplete reduction (>2 mm). Functional outcome was measured with Harris Hip Score (HHS), Oswestry Disability Index (ODI), and Short Form (12) Health Survey (SF12). Radiological parameters were assessed with standing whole spine, pelvis and hip X-rays, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). Follow-up intervals were 1, 3, 6 and 12 months and annually thereafter. Gait analysis and baropodometry were performed after 24 months of operation. Results Mean HHS, ODI, and SF-12 was improved during the first postoperative year in both groups. After two years average scores kept improving for group A, but worsened for group B. Mean PI, PT, and SS increased in both groups during the first postoperative year, with further increase after two years only in group B. After two years, 16 (89%) patients in group A and four (50%) in group B had a balanced spine (SVA <50 mm). Gait analysis and baropodometry showed greater imbalance and overload for group B compared to group A. Conclusion In the long term, incomplete reduction of associated acetabular fractures may lead to poor outcome because of secondary spinopelvic imbalance, with posture and gait impairment.
Lazennec J, Brusson A, Rousseau M. Hip-spine relations and sagittal balance clinical consequences. Eur Spine J 2011:686–98.
2
Borrelli Jjr, Goldfarb C, Ricci W, Wagner J. Engsberg JR. Functional outcome after isolated acetabular fractures. J Orthop Trauma 2002:73–81.
3
Engsberg J, Steger-May K, Anglen J, Jjr B. An analysis of gait changes and functional outcome in patients surgically treated for displaced acetabular fractures. J Orthop Trauma 2009:346–53.
4
Boulay C, Bollini G, Legaye J, Tardieu C, Prat-Pradal D, Chabrol B, et al. Pelvic incidence: a predictive factor for three-dimensional acetabular orientation-a preliminary study. Anat Res Int 2014:594650.
5
Meccariello L, Cioffi S, Grubor P, Franzese R, Cioffi R, Di Giacinto S. Flat back syndrome as post traumatic or post scoliosis treatment disorder of the spine. Med Inv 2013:51–6.
6
Gerbershagen H, Dagtekin O, Isenberg J, Martens N, Ozgür E, Krep H, et al. Chronic pain and disability after pelvic and acetabular fractures-assessment with the Mainz Pain Staging System. J Trauma 2010:128–36.
7
Grubor P, Krupic F, Biscevic M, Grubor M. Controversies in treatment of acetabular fracture. Med Arch 2015:16–20.
8
Tosounidis T, Gudipati S, Panteli M, Kanakaris N, Giannoudis P. The use of buttress plates in the management of acetabular fractures with quadrilateral plate involvement: is it still a valid option? Int Orthop 2015:2219–26.
9
Mears D, Velyvis J, Chang C. Displaced acetabular fractures managed operatively: indication of outcome. Clin Orthop Relat Res 2003:173–86.
10
Dakin G, Eberhardt A, Alonso J, Stannard J, Mann K. Acetabular fracture patterns: associations with motor vehicle crash information. J Trauma 1999:1063–71.
11
Monticone M, Baiardi P, Ferrari S, Foti C, Mugnai R, Pillastrini P, et al. Development of the Italian version of the Oswestry Disability Index (ODI-I): A cross-cultural adaptation, reliability, and validity study. Spine 2009:2090–5.
12
Harris W. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969:737–55.
13
Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed 1993.
14
Carta S, Falzarano G, Rollo G, Grubor P, Fortina M, Meccariello L, et al. Total hip arthroplasty vs osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes. J Acute Dis 2017:12–7.
15
Liebergall M, Mosheiff R, Low J, Goldvirt M, Matan Y, Segal D. Acetabular fractures. Clinical outcome of surgical treatment. Clin Orthop Relat Res 1999:205–16.
16
Tannast M, Najibi S, Matta J. Two to 20-year survivorship of the hip in 810 patients with operatively treated ace-tabular fractures. J Bone Joint Surg Am 2012:1559–67.
17
Giannoudis P, Grotz M, Papakostidis C. Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br 2005:2–9.
18
Borg T, Hailer N. Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients. Arch Orthop Trauma Surg 2015:227–33.
19
Matta J. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1998:1632–45.
20
Olson S, Bay B, Chapman M, Sharkey N. Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum. J Bone Joint Surg Am 1995:1184–92.
21
Shi H, Xiong J, Chen Y, Wang J, Wang Y. Radiographic analysis of the restoration of hip joint center following open reduction and internal fixation of acetabular fractures: a retrospective cohort study. BMC Musculoskelet Disord 2014:277.
22
Boudissa M, Francony F, Kerschbaumer G, Ruatti S, Milaire M, Merloz P, et al. Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: Retrospective study of 414 patients over 10 years. Orthop Traumatol Surg Res 2017:335–9.
23
Kelly J, Ladurner A, Rickman M. Surgical management of acetabular fractures -a contemporary literature review. Injury 2020:2267–77.
24
Cimerman M, Jug K, Tomaževič M, M. Fractures of the acetabulum: from yesterday to tomorrow. Int Orthop 2020.
25
Rommens P, Schwab R, Handrich K, Arand C, Wagner D, Hofmann A. Open reduction and internal fixation of acetabular fractures in patients of old age. Int Orthop 2020:2123–30.
26
Nusser M, Holstiege J, Kaluscha R, Tepohl L, Stuby F, Röderer G, et al. Return to work after fractures of the pelvis and the acetabulum. Z Orthop Unfall 2015:282–8.
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