Predictor variables in acetabular fractures surgically treated.

INTRODUCTION: Up to 25% of acetabular fractures have poor functional outcomes in short-term follow-up. The aim of our study is to analyze predictors related to poor outcome in surgically treated acetabular fractures. Damage to the femoral head cartilage and poor fracture reduction has been reported as predictors to total hip arthroplasty (THA). MATERIAL AND METHODS: retrospective study of 207 consecutive patients with acetabular fractures, over a fourteen-year period. Demographic data, fracture pattern according to AO/OTA, complications related to surgery and predictor variables were analyzed. RESULTS: Analyzing predictor variables, we observed seagull sign, femoral head dislocation, femoral osteochondral damage, acetabular marginal impaction, poor acetabular roof congruency after surgery (p < 0.001) and postoperative fracture congruence (>3mm) (p < 0.023) statistically related to the need of a THA during follow-up. Age (p = 0,98), Sex(p = 0,27), AO-OTA classification (p = 0,10), type of dislocation (p = 0,25), surgical approach (p = 0,57), time to surgery (p = 0,66) and posterior wall involvement (p = 0,06) were not related to THA. Most frequent complication was nerve injury, affecting 22 patients (20.18%). Only seventeen patients (15.6%) needed a THA at an average time of 6 years after initial open reduction and internal fixation. CONCLUSION: Femoral head damage and dislocation, fracture reduction, and seagull sign were the strongest predictors related to THA after surgical treatment of acetabular fractures.

Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases.

BACKGROUND: Factors that impede closed reduction in intertrochanteric fractures remain unknown. This study was designed with the aim of establishing radiological variables that can predict an open reduction when nailing those type of fractures. MATERIALS AND METHODS: Observational prospective study carried out between March 2013 and March 2015. Patients of both gender who suffered an intertrochanteric fracture, and who were surgically treated by intramedullary nailing (PFN-A), were included. Patients were evaluated by means of a questionnaire designed in 12 de Octubre Trauma department. Radiological parameters assessed preoperatively, after fracture reduction in the traction table, and after fixation were: calcar, lateral wall and posterior buttress integrity or disruption; lesser trochanter location, varus or valgus deformities, and flexion or extension of the proximal fragment. RESULTS: Association between open reduction and the following types of fractures was statistically significant (p<0.001): subtypes A2.3, A3.2 and A3.3 of AO classification and subtypes IV and V of Evans classification. There were four radiological parameters associated with the need for open reduction: disruption of lateral wall (p<0.0000), posterior wall fracture (p<0.001), calcar (p<0.004) and malalignment in the axial view (p<0.001). CONCLUSIONS: Open reduction seems to be necessary for complex fracture patterns such as A2.3, A3.2 and A3.3 types of AO/OTA classification, as well as types IV and V of Evans classification. There are four major radiological parameters that can predict the need of approaching the fracture site: posterior buttress, calcar disruption, lateral wall disruption and proximal fragment flexion. The development of high quality evidence regarding this topic is necessary due to the vast impact that open reduction can have on elderly patients.