Clinical Consequences of Hip Instability in Acetabular Fractures with Poor Reduction Quality

Abstract

Aim: The treatment of the acetabular fractures is still an important topic of orthopaedic surgery because of complex anatomy of the acetabulum and serious complications. Although the reduction quality of acetabular fractures is accepted as the most important prognostic factor, the clinical outcome is not always poor in patients with poor reduction quality. The purpose of the present study is to analyze the prognostic effects of subtle hip instability on clinical results after poor reduction of acetabular fractures. Material and Methods: A total of 31 patients were recruited to the study with poor reduction quality after acetabular fracture surgery. The clinical outcome was assessed according to modified Merle d’Aubigné hip scoring. The patients were divided into two groups as good and poor outcome. The time interval between trauma and surgery, associated hip dislocation or pelvic injury, iatrogenic nerve injury, infection, heterotophic ossification, osteoarthritis and subtle hip instability were assessed, whether these factors affected the clinical outcome or not. Results: Twenty-six of the 31 patients were male. The mean age was 40 years and the mean follow-up period was 64 months. The mean time interval between trauma and surgery was 7.7 days. Forteen patients had isolated acetabular fractures while there were associated injuries in remaining 17 patients. Posttraumatic arthritis was the most common complication in this study. The clinical outcome was good in 11 of 31 patients and poor in remaining 20 patients. Subtle hip instability was found to negatively affect clinical outcome. Conclusion: We showed that subtle hip instability would be a useful prognostic factor for the determination of reduction quality. Also, we suggested that subtle hip instability is a more objective method for assessment of reduction quality due to interobserver variability in classification according to Matta criteria.

Keywords

• acetabular fracture
• reduction quality
• subtle hip instability

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