Radiological and Functional Assessment of Treatment Outcomes in Patients after Open Reduction with Internal Fixation (ORIF) of Acetabular Fractures

Emilia Dadura, Aleksandra Truszczyńska-Baszak, Dariusz Szydłowski, Emilia Dadura, Aleksandra Truszczyńska-Baszak, Dariusz Szydłowski

Abstract

(1) Fracture of the pelvis usually happens in young men and results from high-energy trauma. It generates high social and economic costs and results in further health problems. It is therefore important to assess long-term treatment results. (2) The study (NCT04902209) involved 31 patients (mean age 43.6 ± 14.8 years). We conducted fixation assessment on the basis of radiographs and CT scans and functional assessment based on functional scales. (3) We observed more degenerative changes in the less precise reconstruction of the acetabulum (p = 0.075). We did not find statistically significant relationships between the area of surgical approach, the gravity of fracture, and the development of degenerative changes. We did not find statistically significant relationships between patients' functional states and the type of surgical approach or the complexity of the fracture. We found a positive correlation between the time of surgical treatment and patients' functional state (p = 0.04). Patients whose joint surfaces were reconstructed anatomically had significantly higher scores in functional scales (HHS p = 0.05, Merle p = 0.03). (4) Patients after surgical fixation of the acetabulum have low functional abilities. The quality of reconstruction of the loaded surface as well as the length of time post-surgery seems to be essential for the patients' functional state.

Keywords: HHS; Merle d’Aubigne Scale; ORIF; acetabulum fractures; functional assessment; pelvic.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Degenerative changes progression (the arrow—the fracture fissure): (a) acetabular fracture (March 2012); (b) degenerative changes (April 2015); (c) hip arthroplasty (June 2015).
Figure 2
Figure 2
Hip range of motion according to HHS.

References

    1. Rommens P.M. Is there a role for percutaneous pelvic and acetabular reconstruction? Inj. Int. J. Care Inj. 2007;38:463–477. doi: 10.1016/j.injury.2007.01.025.
    1. Caban A., Zawadzki A., Sokólski B., Marczyński W. Ocena wyników leczenia operacyjnego złamań panewki stawu biodrowego. Chir. Narządów Ruchu. 2011;76:336–344.
    1. Firoozabadi R., Spitler C., Schlepp C., Hamilton B., Agel J., Routt M.C., Tornetta P. Determining stability in posterior wall acetabular fractures. J. Orthop. Trauma. 2015;29:465–469. doi: 10.1097/BOT.0000000000000354.
    1. Gänsslen A., Steinke B., Krettek C. Osteosynthese von Frakturen der hinteren Wand des Azetabulums. Oper. Orthop. Traumatol. 2009;21:283–295. doi: 10.1007/s00064-009-1805-5.
    1. Giannoudis P.V., Tzioupis C., Papathanassopoulos A., Obakponovwe O., Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Inj. Int. J. Care Inj. 2010;41:986–995. doi: 10.1016/j.injury.2010.08.003.
    1. Grubor P., Krupic F., Biscevic M., Grubor M. Controversies in treatment of acetabular fracture. Med. Arch. 2015;69:16–20. doi: 10.5455/medarh.2015.69.16-20.
    1. Magu N.K., Gogna P., Singh A., Singla R., Rohilla R., Batra A., Mukhopadhyay R. Long term results after surgical management of posterior wall acetabular fractures. J. Orthop. Traumatol. 2014;15:173–179. doi: 10.1007/s10195-014-0297-8.
    1. Mauffrey C., Hao J., Cuellar D.O., Herbert B., Chen X., Liu B., Zhang Y., Smith W. The epidemiology and injury patterns of acetabular fractures. Are the USA and China comparable? Clin. Orthop. Relat. Res. 2014;472:3332–3337. doi: 10.1007/s11999-014-3462-8.
    1. Papadakos N., Pearce R., Bircher M.D. Low energy fractures of the acetabulum. Ann. R. Coll. Surg. Engl. 2014;96:297–301. doi: 10.1308/003588414X13814021680157.
    1. Wang H., Chen W., Su Y., Li Z., Li M., Wu Z. Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures. Indian J. Orthop. 2012;46:413–419.
    1. Weber K., Kohler H., Vock B., Wentzensen A. Lebensqualität nach Acetabulum- und Beckenringfrakturen. Orthopäde. 2002;31:582–586. doi: 10.1007/s00132-002-0311-3.
    1. Aprato A., Joeris A., Tosto F., Kalampoki V., Stucchi A., Masse A. Direct and indirect costs of surgically treated pelvic fractures. Arch. Orthop. Trauma Surg. 2016;136:325–330. doi: 10.1007/s00402-015-2373-9.
    1. Holstein J.H., Stuby F.M., Herath C.S., Culemann U., Aghayev E., Pohlemann T. Einfluss des Beckenregisters der DGU auf die Versorgung von Beckenringfrakturen. Unfallchirurg. 2016;119:475–481. doi: 10.1007/s00113-016-0168-2.
    1. Culemann U., Tosounidis G., Pohlemann T. Aktuelle Behandlungsstrategien nach Azetabulumfrakturen. Z. Orthopädie Unf. 2009;4:229–248. doi: 10.1055/s-0029-1214946.
    1. Moliere S., Dosch J.C., Bierry G. Pelvic, acetabular and hip fractures: What the surgeon should expect from the radiologist. Diagn. Interv. Imaging. 2016;97:709–723. doi: 10.1016/j.diii.2016.02.010.
    1. McMaster J., Powell J. Acetabular fractures. Curr. Orthop. 2005;19:140–154. doi: 10.1016/j.cuor.2005.03.001.
    1. Hessmann M.H., Ingelfinger P., Dietz S.O., Rommens P.M. Osteosynthese der Frakturen der Vorderwand und des vorderen Pfeilers des Azetabulums über einen ilioinguinalen Zugang. Oper. Orthop. Traumatol. 2009;21:236–250. doi: 10.1007/s00064-009-1802-8.
    1. Quadir R.I., Bukhari S.I. Outcome of operative treatment of acetabular fractures: Short term follow-up. J. Ayub Med. Coll. Abbottabad. 2015;27:287–291.
    1. Missaoui B., Portero P., Bendaya S., Hanktie O., Thoumie P. Posture and equilibrium in orthopedic and rheumatologic diseases. Neurophysiol. Clin. 2008;38:447–457. doi: 10.1016/j.neucli.2008.09.004.
    1. Sziver E., Nagya E., Preszner-Domján A., Pósa G., Horvath G., Balog A., Tóth K. Postural control in degenerative diseases of the hip joint. Clin. Biomech. 2016;35:1–6. doi: 10.1016/j.clinbiomech.2016.04.001.
    1. Arokoski J.P.A., Leinonen V., Arokoski M.H., Aalto H., Valtonen H. Postural control in male patients with hip osteoarthritis. Gait Posture. 2006;23:45–50. doi: 10.1016/j.gaitpost.2004.11.017.
    1. Giannoudis P.V., Nikolau V.S., Kheir E., Mehta S., Stengel D., Roberts C.S. Factors determining quality of life and level of sporting activity after internal fixation of an isolated acetabular fracture. J. Bone Jt. Surg. 2009;91:1354–1359. doi: 10.1302/0301-620X.91B10.22572.
    1. Lang P., Schnegelberger A., Riesner H.J., Stuby F., Friemert B., Palm H.G. Einfluss von operativ versorgten Beckenring- und Azetabulumfrakturen auf die posturale Kontrolle. Z. Orthop. Unf. 2016;154:174–180. doi: 10.1055/s-0041-110811.
    1. Judet R., Judet J., Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report. J. Bone Jt. Surg. Am. 1964;46:1615–1646. doi: 10.2106/00004623-196446080-00001.
    1. Harris W.H. 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 Jt. Surg. Am. 1969;51:737–755. doi: 10.2106/00004623-196951040-00012.
    1. D’Aubigne R.M., Postel M. The Classic: Functional results of hip arthroplasty with acrylic prosthesis. Clin. Orthop. Relat. Res. 2009;467:7–27. doi: 10.1007/s11999-008-0572-1.
    1. Triantaphillopoulos P.G., Panagiotopoulos E.C., Mousafiris C., Tyllianakis M., Dimakopoulos P., Lambiris E.E. Long-term results in surgically treated acetabular fractures through the posterior approaches. J. Trauma. 2007;62:378–382.
    1. Floris I., Bodzay T., Vendegh Z., Gloviczki B., Balazs P. Short-term results of total hip replacement due to acetabular fractures. Eklem Hastalik. Cerrahisi. 2013;24:64–71. doi: 10.5606/ehc.2013.16.
    1. Fölsch C., Alwani M.M., Jurow V., Stiletto R. Operative Therapie der Acetabulumfraktur beim älteren Patienten. Osteosynthese oder Endoprothese. Unfallchirurg. 2015;118:146–154. doi: 10.1007/s00113-014-2606-3.
    1. Matta J.M. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J. Bone Jt. Surg. Am. 1996;78:1632–1645. doi: 10.2106/00004623-199611000-00002.
    1. Maia M.S., Santos D.C., de Queiroga D.M., de Oliveira Castro C., Silva R.M., Reis A.C., Ducatti A.C. Epidemiological analysis on acetabular fractures. Rev. Bras. Ortop. 2011;46:23–26. doi: 10.1590/S0102-36162011000100004.
    1. Uchida K., Kokubo Y., Yayama T., Nakajima H., Miyazaki T., Negoro K., Takeno K., Sawaguchi T., Watanabe S., Sugita D., et al. Fracture of the acetabulum: A retrospective review of ninety-one patients treated at a single institution. Eur. J. Orthop. Surg. Traumatol. 2013;23:155–163. doi: 10.1007/s00590-012-0938-7.
    1. Moed B.R. A thirty-year perspective on posterior wall fractures of the acetabulum: Enigma or just another intra-articular injury. J. Taibah Univ. Med. Sci. 2016;11:179–186. doi: 10.1016/j.jtumed.2016.02.002.
    1. Culemann U., Tosounidis G., Pohlemann T. Die Therapie bei Azetabulumfrakturen—Aktuelle Diagnostik und Behandlungsstrategie. Zent. Chir. 2005;130:W58–W71. doi: 10.1055/s-2005-836926.
    1. Bahat N.A., Kangoo K.A., Wani I.H., Wali G.R., Muzaffar N., Dar R.A. Operative management of displacement acetabular fractures: An institutional experience with a midterm follow-up. Ortop. Traumatol. Rehabil. 2014;3:245–252. doi: 10.5604/15093492.1112281.
    1. Schlickewei W., Kuner E.H., Elsässer B. Langzeitergebnisse und Spätschäden nach Hüftpfannenfrakturen. Orthopäde. 1997;26:375–383. doi: 10.1007/s001320050105.
    1. Nusser M., Holstiege J., Kaluscha R., Tepohl L., Stuby F., Röderer G., Krischak G. Berufliche Wiedereingliederung nach Becken- und Azetabulumfrakturen. Z. Orthop. Unf. 2015;153:282–288. doi: 10.1055/s-0034-1396261.
    1. Ovre S., Sandvik L., Madse J.E., Roise O. Modification of the Harris hip score in acetabular fracture treatment. Injury. 2007;38:344–349. doi: 10.1016/j.injury.2006.04.129.
    1. Kalairajah Y., Azurza K., Hulme C., Molloy S., Drabu K.J. Health outcome measures in the evaluation of total hip arthroplasties—A comparison between the Harris hip score and the Oxford hip score. J. Arthroplast. 2005;20:1037–1041. doi: 10.1016/j.arth.2005.04.017.
    1. Kirmit L., Karatosun V., Unver B., Bakirhan S., Sen A., Gocen Z. The reliability of hip scoring systems for total hip arthroplasty candidates: Assessment by physical therapists. Clin. Rehabil. 2005;19:659–661. doi: 10.1191/0269215505cr869oa.
    1. Ugino F.K., Righetti C.M., Alves D.P.L., Guimarães R.P., Honda E.K., Ono N.K. Evaluation of the reliability of the modified Merle d’Aubigné and Postel Method. Acta Ortop. Bras. 2012;20:213–217. doi: 10.1590/S1413-78522012000400004.
    1. Dindorf C., Teufl W., Taetz B., Becker S. Feature extraction and gait classification in hip replacement patients on the basis of kinematic waveform data. Biomed. Hum. Kinet. 2021;13:177–186. doi: 10.2478/bhk-2021-0022.
    1. Maurer F., Mutter B., Weise K., Belzl H. Rehabilitation nach Hüftgelenkfrakturen. Orthopäde. 1997;26:368–374. doi: 10.1007/s001320050104.

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