Session VII - Pelvis

Fri., 10/6/06 Pelvis, Paper #42, 4:00 pm

Outcomes of Acetabular Fracture Reconstruction Surgery: The Time-Critical Effect of Delay

Rohit Kotnis, MD (n); Rachala Madhu, MD (n); Ahmed Al-Mousawi, MD (n); Neil Barlow, MD (n); Sunny Deo, MD (n); Peter Worlock, MD (n); Keith Willett, MD (n);
Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom

Background/Hypothesis: Referral to centers with a pelvic service is standard practice for the management of displaced acetabular fractures. We hypothesize that the "time to surgery" (1) is a predictor of radiologic and functional outcome, and (2) this varies with the fracture pattern.

Patients/Methods: We conducted a retrospective case review of 254 patients in whom a displaced acetabular fracture was reduced and stabilized at a tertiary referral center over a 10-year period (March 1991 to July 2001). Patients were divided into two groups based on fracture pattern: elementary or associated. Time to surgery from injury was analyzed as a continuous and a stratified variable (1-5, 6-10, 11-15, 16-20, >20 days). The primary outcome measures were the quality of reduction and functional outcome at a minimum follow-up of 2 years. Logistic regression analysis was used to test our hypothesis, while controlling for potential confounding variables (age, presence of dislocation, sciatic nerve injury, and associated injuries).

Results: For elementary fractures, an increase in the time to surgery of one day reduced the odds of an excellent/good functional result by an average 15% (P = 0.001) and of an anatomic reduction by 18% (P = 0.0001). For associated fractures, the odds of obtaining an excellent/good result were reduced by 19% (P = 0.0001) and an anatomic reduction by an average 18% (P = 0.0001) per day. These were nonlinear. For elementary fractures, there was no significant difference in the odds of obtaining an anatomic reduction when comparing patients operated in the time periods 1-5, 6-10, and 11-15 days. Significance was first reached when the time to surgery was more than 15 days (P = 0.004). For associated fractures, significance was first reached when the time to surgery was more than 5 days (P = 0.008). An excellent/good functional outcome was more likely when surgery was performed within 15 days (elementary) and 10 days (associated).

Conclusion: The time to surgery is a significant predictor of radiologic and functional outcome for both elementary and associated displaced acetabular fractures. The organization of regional trauma systems must be capable of satisfying these time-critical targets to achieve optimal patient outcome.

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· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.