For example, surgery is recommended for a roof-arc angle of <40° in at least one radiographic view (anterior-posterior (AP) or 45° oblique) of the pelvis ( 9, 10, 11), as a parameter of fracture displacement. For this purpose, various criteria have been described, additionally to the fracture classification, to support the decision process regarding both fracture-related and patient-related factors.įracture-related factors, which shift the treatment decision toward surgery, include the biomechanical stability (according to the fracture type based on the Letournel classification), the grade of displacement, and the grade of fracture comminution. In consequence, the decision for or against surgical treatment is often the key to successful treatment of acetabular fractures ( 9). from screw loosening due to lower bone quality) and additionally, they are at higher risk for a worse functional outcome of the injured hip joint ( 5, 6), whereas the functional requirements are lower. However, older patients have a relatively higher perioperative mortality and morbidity risk ( 7) (e.g. Due to the demographic change, more elderly patients with an acetabular fracture were treated surgically ( 1, 2). However, it must, of course, be ensured that even if surgical treatment is sought promptly (should it actually be necessary), this should always be carried out with the same quality and after equal careful preoperative preparation and improvement of the patient’s overall status. Thus, in the short term, the aim of osteosynthetic treatment is the stabilization of the fragments and hence, a reduction in pain as well as the possibility of early mobilization. This can often only be achieved satisfactorily by surgical treatment. On the contrary, early treatment and mobilization should be aimed at the elderly in order to avoid secondary complications associated with immobilization ( 7, 8). This is of great importance, especially in younger patients ( 5, 6). The primary goal of surgery in acetabular fractures is the anatomic reconstruction of the articular surface to avoid long-term complications such as posttraumatic osteoarthritis with the need for arthroplasty. The groundbreaking work of Robert Judet and Emile Letournel in the mid-1960s led to a change in the decisions regarding the therapy regime ( 3, 4), and consequently, there has been an increase in the proportion of surgically treated fractures ( 1).Īims of acetabular fracture management, either surgical or conservative, are in the short-term pain relief and early mobilization of the patients and in the long term, the prevention of posttraumatic osteoarthritis due to the incongruence of the hip joint. The standard therapy used to be non-operative treatment for a long time ( 3). Therefore, therapy is often challenging, even for experienced trauma surgeons. Further studies are needed to determine the relevance of these factors, and whether they should be used for the decision-making process, in particular surgeons with less experience in pelvic surgery, can orient themselves to.Īcetabular fractures are rare injuries with an incidence of 3/100,000/year ( 1, 2). The most frequent reason for non-operative treatment was ‘minimal displacement’ in 42.2%.īesides fracture classification and fracture characteristics, no factors characterizing the overall injury, except for the ISS, and unexpectedly gender, are important for making a treatment decision. Apart from the injury severity score (ISS), factors that characterize the overall picture of the injury were of no importance for the indication of a surgical therapy (isolated pelvic fracture: 62.0%, polytrauma: 58.8%). In total, 51.4% of women and 66.0% of men underwent surgery. Also, larger fracture gaps were treated surgically more often than fractures with smaller gaps (>3 mm 84.4%, <1 mm 20%). Anterior wall fractures were treated surgically in 10.2%, and posterior column plus posterior wall fractures were operated on in 90.2%. The fracture classification is important for the indication of surgical therapy. In total, 25.8% of all registered patients suffered from an acetabular fracture and 61.9% of them underwent surgery. Furthermore, a logistic regression model with surgical treatment as the dependent variable was established. Therefore, coming up with an accurate decision, whether surgical treatment is indicated or not, is the key to successful therapy.ĭata from the German pelvic Trauma Registry ( n = 4213) was evaluated retrospectively, especially regarding predictors for surgery. ![]() Yet, stability and congruity of the hip joint need to be achieved to ensure early mobilization, painlessness, and good function. Treatment of acetabular fractures is challenging and risky, especially when surgery is performed.
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