Results of 75 Consecutive Patients With An Acetabular Fracture

From 1988 to 1991, 75 consecutive patients with an acetabular fracture were treated. Follow up was for a minimum of 2 years (average, 3 years; range, 2-5 years). Sixty five patients had a solitary acetabular fracture, and in 10 the acetabular fracture was associated with a pelvic fracture (52 men and 23 women; average age, 46 years; range, 17 to 99 years). Twenty four patients were treated nonoperatively (average age, 46 years; range, 12 to 99 years), and 51 underwent surgery (average age, 45 years; range, 17 to 92 years). The indications for surgery were: displacement of the fracture of > 2 mm; an intraarticular fragment interfering with joint movement; posterior instability of the joint with a luxating femoral head; insufficient roof arc; or to prepare the joint for total hip replacement. The patients were classified according to Letournel. Nonoperative treatment consisted of traction or nonweightbearing mobilization during an average period of 2 weeks. The surgical approaches used were: the Kocher-Langenbeck (22); the ilioinguinal (18); and the extended iliofemoral (4). More than 1 approach was used in 3 cases; external fixation was used in 4. All patients received prophylactic treatment of indomethacin. Six developed heterotopic ossification. Preoperatively, 6 patients had a paresis or paralysis from which 5 recovered. Pre- and postoperative nerve lesions occurred in 3 patients from which 2 recovered. One patient died perioperatively of pulmonary embolus. In 2 patients a collapse of the posterior wall resulted in a total hip replacement. The results were good to excellent according to the d'Aubigne scale in 76% of all patients.