Treatment protocol, results and complications of operative treatment of displaced acetabular fractures

This is a prospective study on the medium and long-term results of the operative treatment of 74 patients with a total of 75 acetabular fractures with at least 5 mm displacement, involving at least one column in a nine years period. Plain radiographs and CT scans were used pre- and postoperatively for evaluation of the reduction of fragments. The approaches used included the Kocher-Langenbeck, ilioinguinal, and extensile iliofemoral. The patients were followed for an average of 53 months (range 28-12 months). Postoperatively the radiographic fragment reduction was excellent in 44%, good in 36%, fair in 12% and poor in 8% cases, whereas the clinical results were 32%, 38%, 15% and 15% respectively. Complications were observed in 21 patients, but only in 11 (14%) were they associated with significant clinical impairment needing additional procedures. Particularly, heterotopic ossification (24%) and subcutaneous infection (1.3%) were mostly observed after extensile exposure (p<0.001), whereas posttraumatic arthrotic changes were noted in 6 and avascular femoral head necrosis in 4 additional patients. Two transient femoral nerve pareses were observed at the beginning of the learning curve with the ilioinguinal approach. The results show that the operative treatment of displaced acetabular fractures offers the experienced trauma surgeon good medium- and long-term results, reduces the risks of long bed-rest by allowing early mobilization, and reduces the rate of early and late complications.