Acetabulum reconstruction: A demanding surgery

Abstract

Introduction: Incidence of fracture in acetabulum is rising and requires anatomical reduction and fixation for proper functioning hip joint. Earlier majority of such fractures were treated conservatively with occasional satisfactory results. Its surgical management is technically demanding but is evolving fast. Material and Methods: Eighteen surgically managed patients in last 2 years were included in the study. On admission, patients were stabilized first the associated dislocation was reduced and maintained on traction. Surgery was planned as soon as general condition permitted after radiological evaluation. Surgical approach depends upon site and pattern of fracture. Postoperative radiological results were assigned according to the criteria described by Matta (Matta JM. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996;78:1632-45) and functional results were evaluated using Merle d Aubigne and Postel s system modified by Matta et al. (Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum: A retrospective analysis. Clin Orthop Relat Res 1986;230-40) after a minimum 6-month follow-up. Results: According to the Merle d Aubigne and Postel scoring system modified by Matta, the clinical outcome was excellent in 9 cases (50%), good in 5 cases (27.7%), fair in 3 cases (16.6%), and poor in 1 case (5.5%). In our series, the overall incidence of sciatic nerve palsy was seen in 2 cases (11%), and other nerve damage was not seen. In our study, all patients received mechanical prophylaxis, and just one patient developed pulmonary embolism. This is in concordance with result of an Indian study. (Shrestha D, Dhoju D, Shrestha R, Sharma V. Acetabular fracture: Retrospective analysis of thirty three consecutive cases with operative management. Kathmandu Univ Med J (KUMJ) 2014;12:279-87.) In our study, deep infection was seen in one case, i.e., 5.5%, and two cases (i.e., 11%) had superficial infection. Conclusion: Nowadays open reduction internal fixation is the gold standard for the displaced acetabulum fractures. A good-to-excellent functional outcome was seen in more than 60% of the patients and a good-to-excellent radiological outcome was seen in more than 50% of the patients treated surgically.