Functional Outcome of Surgical Stabilisation of Acetabular Fractures

Introduction: Approach to the management of displaced acetabular fractures has evolved from conservative to operative management after the work of Judet and Letournel. Various surgical methods have been explored and described by authors to address this type of fracture, leading to improved clinical outcome. This study aimed to evaluate functional outcome of surgically treated displaced acetabular fractures in the Malaysian context.

Materials and methods: We analysed 43 patients with isolated acetabular fractures who were treated operatively with a minimum of three years follow-up. Anthropometric data, Judet-Letournel fracture pattern, surgical approach and complications were recorded. Post-operative Matta radiological outcome were evaluated for joint congruency and hip functional outcome was evaluated using Merle d'Aubgine-Postel and Harris Hip Score (HHS). All statistical analyses were analysed using SPSS version 24.0.

Results: The most frequent elementary fracture type was posterior wall (30.2%) while associated type was both columns (23.3%). Mean functional outcome of Merle d'Aubigné-Postel was 15.77 and HHS was 86.6. Thirty-three (76.7%) patients achieved satisfactory functional outcome, 19 (44.1%) patients achieved anatomic reduction (<2 mm step-off) based on Matta classification while 24 (55.8%) did not achieve the desired outcome. Fracture pattern exhibited strong association with post-operative Matta radiological outcome (p-value 0.001). However both fracture pattern and Matta radiological outcome did not exhibit association with the functional outcome group. The mean time for surgical interventions was 10.8 days and there was no significant association with final functional outcome score.

Conclusion: Fracture pattern is a strong contributing factor towards post-operative Matta radiological outcome. However, achieving the perfect anatomical reduction is not of utmost important factor to predict the good functional outcome.