Surgical management of acetabular fractures - A contemporary literature review
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abstract
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Surgical management of acetabular fractures is now commonplace for
almost all displaced or unstable fractures. Over the last 20 years
however, the patient population has aged, and there have been
significant changes to safety in motor vehicles and the work-place,
and people's activity types and levels have changed. The surgical
specialty has also developed with time, and as a result acetabular
fracture surgery today is different to 20 years ago. We have
repeated a meta-analysis originally published by Giannoudis et al in
2005, to evaluate contemporary aspects of acetabular fracture
patients, injury mechanisms, management, complications and
functional outcomes. This paper compares data from the last 15 years
to that published in 2005. We have analysed a total of 8389
fractures from 8372 patients. The mean patient age has risen from
38.6 to 45.2. A change in injury mechanisms is seen, with road
traffic accidents now accounting for 66.5% of cases (previously over
80%), and a rise in the number of fractures caused by falls from
10.7 to 25.8%. There has been a marked change in the fracture types
seen, with a significant rise in anterior column-based fractures
(Anterior column and Anterior column posterior hemi-transverse),
whilst all other fracture patterns have fallen over time. Surgery is
now taking place earlier, the Kocher-Langenbeck and Ilioinguinal
approaches remain the major surgical approaches used, but the
Anterior Intra-Pelvic approach has become relatively common. The
most significant change in complications is a substantial drop in
iatrogenic nerve damage, particularly to the sciatic nerve.
Post-traumatic osteoarthritis remains the major complication of this
injury, with 16.9% of cases developing Matta grade III/IV changes by
44 months in this review. Heterotopic ossification also remains a
common problem. Despite these changes over time, functional outcomes
after acetabular fracture appear to remain similar, although there
is still a lack of good quality data on medium and longer-term
functional outcomes from which to assess this.
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citation
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Kelly J, Ladurner A, Rickman M. Surgical management of acetabular
fractures - A contemporary literature review. Injury 2020;
51:2267-2277.
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type
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journal paper/review (English)
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date of publishing
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24-06-2020
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journal title
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Injury (51/10)
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ISSN electronic
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1879-0267
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pages
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2267-2277
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PubMed
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32646650
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DOI
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10.1016/j.injury.2020.06.016
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