Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established.Aims
Methods
We performed a systematic review of the literature
pertaining to the functional outcomes of the surgical management
of acetabular fractures. A total of 69 articles met our inclusion
criteria, revealing that eight generic outcome instruments were
used, along with five specific instruments. The majority of studies
reported outcomes using a version of the d’Aubigne and Postel score,
which has not been validated for use in acetabular fracture. Few validated
outcome measures were reported. No psychometric testing of outcome
instruments was performed. The current assessment of outcomes in
surgery for acetabular fractures lacks scientific rigour, and does
not give reliable outcome data for either scientific comparison
or patient counselling. Take home message: The use of non-validated functional outcome
measures is a major limitation of the current literature pertaining
to surgical management of acetabular fractures; future studies should
use validated outcome measures to ensure the legitimacy of the reported
results. Cite this article:
We performed a systematic review of the literature
to evaluate the use and interpretation of generic and disease-specific
functional outcome instruments in the reporting of outcome after
the surgical treatment of disruptions of the pelvic ring. A total
of 28 papers met our inclusion criteria, with eight reporting only
generic outcome instruments, 13 reporting only pelvis-specific outcome
instruments, and six reporting both. The Short-Form 36 (SF-36) was
by far the most commonly used generic outcome instrument, used in
12 papers, with widely variable reporting of scores. The pelvis-specific
outcome instruments were used in 19 studies; the Majeed score in
ten, Iowa pelvic score in six, Hannover pelvic score in two and
the Orlando pelvic score in one. Four sets of authors, all testing construct
validity based on correlation with the SF-36, performed psychometric
testing of three pelvis-specific instruments (Majeed, IPS and Orlando
scores). No testing of responsiveness, content validity, criterion
validity, internal consistency or reproducibility was performed. The existing literature in this area is inadequate to inform
surgeons or patients in a meaningful way about the functional outcomes
of these fractures after fixation.
We describe our early operative experience with a new pelvic reduction frame and the standard of reduction of fractures of the pelvic ring which we achieved in the first 35 consecutive patients, with 34 acute fractures and one nonunion. The pre-operative and immediate post-operative radiographs were measured, using two methods, to find the maximum radiological displacement of the fracture and the quality of the reduction according to the criteria of Tornetta and Matta. There were 19 vertical shear fractures and 16 compression injuries. The mean age of the patients was 33.5 years (10 to 59) and mean delay to surgery was 4.6 days (0 to 16) in the 34 acute injuries. The mean operative time in isolated procedures was 103.4 minutes ( The frame was shown to be effective, allowing the surgeon to obtain a satisfactory reduction and fixation of acute displaced disruptions of the pelvic ring.
Our aim was to determine the effect of delay to surgery on the time to discharge, in-hospital death, the presence of major and minor medical complications and the incidence of pressure sores in patients with a fracture of the hip. All patients admitted to Vancouver General Hospital with this injury between 1998 and 2001 inclusive were identified from our trauma registry. A review of the case notes was performed to determine the delay in time from admission to surgery, age, gender, type of fracture and medical comorbidities. A time-to-event analysis was performed for length of stay. Additionally, a Cox proportional hazards model was used to determine the effect of delay to surgery on the length of stay while controlling for other pertinent confounding factors. Using logistical regression we determined the effect of delay to surgery on in-hospital death, medical complications and the presence of pressure sores, while controlling for confounding factors. Delay to surgery (p = 0.0255), comorbidity (p <
0.0001), age (p <
0.0001) and type of fracture (p = 0.0004) were all significant in the Cox proportional hazards model for increased time to discharge. Delay to surgery was not a significant predictor of in-hospital mortality. However, a delay of more than 24 hours was a significant predictor of a minor medical complication (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.05 to 2.22), while a delay of more than 48 hours was associated with an increased risk of a major medical complication (OR 2.21, 95% CI 1.01 to 4.34), a minor medical complication (OR 2.27, 95% CI 1.38 to 3.72) and of pressure sores (OR 2.29, 95% CI 1.19 to 4.40). Patients with a fracture of the hip should have surgery early to lessen the time to acute-care hospital discharge and to minimise the risk of complications.
