OTA 1997 Posters - Pelvic & Acetabular Fractures

Functional Outcome following Acetabular Fractures Involving the Posterior Wall

David Stephen, Bsc,MD,FRCS(C), Hans Kreder, MD, MPH,FRCS(C), Adrian Day, MBB Chir,BMedBiol,FRCS(Orth), Mike McKee, MD,FRCS(C), Emil Schemitsch, MD,FRCS(C)

Sunnybrook Health Science Center, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada

Purpose: To review functional outcomes for individuals with posterior wall acetabular fractures and to identify factors associated with outcome.

Conclusion: At follow-up, individuals with posterior wall acetabular fractures exhibit profound functional deficits compared to the normal population.

Significance: Previous work has focused on radiographic and clinical outcomes with the suggestion that acetabular fractures involving the posterior wall generally have good outcomes. We have shown that patient function is severely affected by this injury. Factors affecting functional outcome have been identified, and a link between radiographic arthritis and functional outcome has been made. Functional outcome should be included in future clinical assessments.

Summary of Method, Results, and Discussion: Seventy-four patients with an acetabular fracture involving the posterior wall were retrospectively reviewed from the prospective trauma database at two level 1 trauma centers. All charts and radiographs were reviewed by a single observer who was blinded to patient outcome. Forty-two patients with identical demographics to the larger group of 74 completed validated functional assessment questionnaires (SF-36 and MFA) at a mean follow-up of 4.25 years (range 1-14). Two patients were excluded from further analysis as they had undergone successful total hip arthroplasty.

SF-36 scores in the physical domains were well below population norms for the group as a whole (physical function mean score =56). Mental health scores were relatively normal (mental health mean score = 76). There were 32 patients who were working outside of the home at the time of injury. Twenty-four of these individuals (75%) were working at follow-up, however 10 (42%) of these patients had changed jobs because of their injury. The eight patients who were not working outside the home due to their injury (25%) had no plans to ever return to work. MFA scores were worse for those patients with radiographic osteoarthritis, associated lower extremity injury, and intra-articular fragments(p< .05).

There was a significant association between radiographic evidence of osteoarthritis and the presence of a femoral head lesion, initial posterior wall fragment displacement, the presence of intra-articular fragments (p< .05). There was a trend for an association between radiographic arthritis and marginal impaction (p=.07).