Session X - Pelvis/Geriatrics

Results of 107 Complex Acetabular Fractures Operated on through the Extended Iliofemoral Approach

David B. Griffin, MD; Paul E. Beaulé, MD; Joel M. Matta, MD, Good Samaritan Hospital, Los Angeles, CA

Purpose: There remains a paucity of data on the results of complex acetabular fractures treated through extended lateral approaches to the hip. We present a single surgeon's experience with the extended iliofemoral approach (EIF), as described by Letournel, for the treatment of these fractures.

Methods: A review of the senior author's computerized database of 833 fractures identified 156 EIF approaches; of these, 107 patients had a minimum follow-up of 2 years. The average patient age was 34 years (range, 13 to 79), and there were 67 men and 40 women. The fracture types included: BC, 65; TR+PW, 15; T, 12; T+PW, 7; TR. 4; ACH, 3; and AC, 2. The time to surgery for 74 patients was less than 21 days after injury and more than 21 days for 33 patients. Twenty-one percent of the patients had an associated head injury and 6% had undergone prior surgery.

Results: At a mean follow-up of 5.4 years (range, 2 to 17) 100% of the fractures achieved union. Reduction was anatomic in 74 hips (69%), imperfect in 27 hips (25%), and poor (>3 mm) in 6 hips (6%). The D'Aubigné/Postel score averaged 15 (range, 5 to 18) with 63% good or excellent results. Nine percent of the patients had wound complications: seven infections, two seromas, and one skin-edge necrosis; 56% of the patients developed heterotopic ossification, of which 16% required excision. Seven percent of the patients required a total hip arthroplasty, 4% hip arthrodesis, and 8% debridement. One total hip-arthroplasty case required revision at 2 years for recurrent instability.

Discussion and Conclusion: The percentage of good to excellent results correlated closely with the percentage of anatomic reductions and is deemed acceptable because the EIF is selected for the more difficult fracture patterns and malunions. In addition, functional outcome was significantly correlated to the accuracy of reduction (P < 0.0095). Time to surgery did not affect functional outcome or capacity to achieve accurate reduction. We conclude that this approach is safe and effective in the management of these complex fractures, but we recommend that only those with appropriate training use the EIF approach.