Fracture characteristics and outcomes of acetabular fracture management with minimally invasive approach and percutaneous fixation

• Published in: European journal of orthopaedic surgery & traumatology 2021-10, Vol.31 (7), p.1363-1368
• Main Authors: Debuka, Ekansh, Kumar, Gunasekaran, Dalal, Neel, Kalra, Sanjay
• Format: Article
• Language: English
• Subjects: Age; Arthritis; Demographics; Fractures; Frailty; Hip joint; Injuries; Laparoscopy; Medicine; Medicine & Public Health; Minimally invasive surgery; Original Article; Orthopedics; Osteoarthritis; Patients; Rehabilitation; Statistical analysis; Surgery; Surgical Orthopedics; Surgical techniques; Traumatic Surgery
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-021-02886-5

Purpose The aim was to assess acetabular fracture outcomes of percutaneous fixation (PF) with or without minimally invasive surgery (MIS). Methods Between July 2011 and October 2016, acetabular fractures fixed with PF with or without MIS were included. Data collected are demographics, mechanism of injury, associated injuries, time to surgery, American Society of Anesthesiologists grade, fracture characteristics, surgical techniques, fracture reduction, secondary osteoarthritis (OA), revision surgery, patient survival and complications. Results Of 26 patients with a mean age of 56 years (19–86) (22 males and 4 females), 11 were  50 years (A50). Most common pattern was anterior column with posterior hemi-transverse. Three out of 11 U50 were minimally displaced and had PF only; the rest had MIS and PF. All had good fracture reduction, but 2 had secondary OA at follow-up but no further surgery. Eight out of 26 had secondary OA but only 3 needed surgery. Three (A50 with PF) with fair/poor reduction (deemed unfit for open reduction) had secondary OA but no further intervention. Three more (A50 with MIS + PF) had secondary OA treated with primary total hip replacement (THR). Complications were as follows: one foot drop recovered after immediate repositioning of screw, one cardiac event and one pulmonary embolism. Conclusion Fracture mal-reduction predicts secondary OA, but good fracture reduction does not prevent secondary OA. MIS and PF in elderly are useful even with suboptimal reduction as it sets the bed for a non-complex THR. Despite MIS surgery, medical complications are potentially significant.