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Can CT-based gap and step-off displacement predict outcome after nonoperative treatment of acetabular fractures?
Trouwborst, Neeltje M; Ten Duis, Kaj; Banierink, Hester; Doornberg, Job N; van Helden, Sven H; Hermans, Erik; van Lieshout, Esther M M; Nijveldt, Robert; Tromp, Tjarda; Stirler, Vincent M A; Verhofstad, Michael H J; de Vries, Jean Paul P M; Wijffels, Mathieu M E; Reininga, Inge H F; IJpma, Frank F A.
Affiliation
  • Trouwborst NM; Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
  • Ten Duis K; Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
  • Banierink H; Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
  • Doornberg JN; Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
  • van Helden SH; Department of Trauma Surgery, Isala Hospital, Zwolle, Netherlands.
  • Hermans E; Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
  • van Lieshout EMM; Trauma Research Unit Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
  • Nijveldt R; Department of Trauma Surgery, Isala Hospital, Zwolle, Netherlands.
  • Tromp T; Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
  • Stirler VMA; Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
  • Verhofstad MHJ; Military Health Organisation, Ministry of Defense, Utrecht, Netherlands.
  • de Vries JPPM; Trauma Research Unit Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
  • Wijffels MME; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
  • Reininga IHF; Trauma Research Unit Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
  • IJpma FFA; Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Bone Joint J ; 105-B(9): 1020-1029, 2023 Sep 01.
Article in En | MEDLINE | ID: mdl-37652442
ABSTRACT

Aims:

The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a total hip arthroplasty (THA), and to determine predictors for conversion to THA in patients treated nonoperatively for acetabular fractures.

Methods:

A multicentre cross-sectional study was performed in 170 patients who were treated nonoperatively for an acetabular fracture in three level 1 trauma centres. Using the post-injury diagnostic CT scan, the maximum gap and step-off values in the weightbearing dome were digitally measured by two trauma surgeons. Native hip survival was reported using Kaplan-Meier curves. Predictors for conversion to THA were determined using Cox regression analysis.

Results:

Of 170 patients, 22 (13%) subsequently received a THA. Native hip survival in patients with a step-off ≤ 2 mm, > 2 to 4 mm, or > 4 mm differed at five-year follow-up (respectively 94% vs 70% vs 74%). Native hip survival in patients with a gap ≤ 2 mm, > 2 to 4 mm, or > 4 mm differed at five-year follow-up (respectively 100% vs 84% vs 78%). Step-off displacement > 2 mm (> 2 to 4 mm hazard ratio (HR) 4.9, > 4 mm HR 5.6) and age > 60 years (HR 2.9) were independent predictors for conversion to THA at follow-up.

Conclusion:

Patients with minimally displaced acetabular fractures who opt for nonoperative fracture treatment may be informed that fracture displacement (e.g. gap and step-off) up to 2 mm, as measured on CT images, results in limited risk on conversion to THA. Step-off ≥ 2 mm and age > 60 years are predictors for conversion to THA and can be helpful in the shared decision-making process.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Spinal Fractures / Arthroplasty, Replacement, Hip / Hip Fractures Type of study: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limits: Humans / Middle aged Language: En Journal: Bone Joint J Year: 2023 Document type: Article
Fulltext
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PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Spinal Fractures / Arthroplasty, Replacement, Hip / Hip Fractures Type of study: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limits: Humans / Middle aged Language: En Journal: Bone Joint J Year: 2023 Document type: Article