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.
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.
2.
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.
3.
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.
4.
Cimerman M, Jug K, Tomaževič M, M. Fractures of the acetabulum: from yesterday to tomorrow. Int Orthop. 2020;
5.
Kelly J, Ladurner A, Rickman M. Surgical management of acetabular fractures -a contemporary literature review. Injury. 2020;2267–77.
6.
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.
7.
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.
8.
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.
9.
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.
10.
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.
11.
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.
12.
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.
13.
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.
14.
Lazennec J, Brusson A, Rousseau M. Hip-spine relations and sagittal balance clinical consequences. Eur Spine J. 2011;686–98.
15.
Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. 1993;
16.
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.
17.
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.
18.
Dakin G, Eberhardt A, Alonso J, Stannard J, Mann K. Acetabular fracture patterns: associations with motor vehicle crash information. J Trauma. 1999;1063–71.
19.
Mears D, Velyvis J, Chang C. Displaced acetabular fractures managed operatively: indication of outcome. Clin Orthop Relat Res. 2003;173–86.
20.
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.
21.
Grubor P, Krupic F, Biscevic M, Grubor M. Controversies in treatment of acetabular fracture. Med Arch. 2015;16–20.
22.
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.
23.
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.
24.
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.
25.
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.
26.
Borrelli Jjr, Goldfarb C, Ricci W, Wagner J. Engsberg JR. Functional outcome after isolated acetabular fractures. J Orthop Trauma. 2002;73–81.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
