Fri., 10/17/08 Pelvis/Injury Prevention, Paper #30, 11:56 am OTA-2008
Effect of Delay to Surgery on Functional Outcomes for Displaced Acetabular Fractures
Richard J. Jenkinson, MD, FRCSC (n); Marcella A.W. Maathuis (n);
Bill Ristevski, MD (n); Dan Omoto, MD (n); David J.G. Stephen, MD, FRCSC (n);
Hans J. Kreder, MD, MSC, FRCSC (n);
University of Toronto Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
Purpose: Our objective was to determine the effect of delay to surgery on functional outcome in patients with displaced acetabular fractures treated operatively.
Methods: 232 patients with operatively treated acetabular fractures were identified from a pelvic trauma database. Functional outcome data were assessed using the validated Musculoskeletal Functional Assessment (MFA) and the Short Form 36 (SF-36) surveys in 162 patients. After 1997, functional outcome scores were collected prospectively at 6 months, 1 year, and 2 years (or greater) postoperatively. Functional outcome scores, quality of reduction on standard radiographs, and risk of complications were modeled as a function of days of delay to surgery via multivariate regression analysis adjusting for age, gender, fracture type, and associated injuries.
Results: At 6 months postoperatively, functional outcome scores were significantly worse with increasing delay to surgery. A delay of between 7 and 13 days or 14 or more days decreased the SF-36 physical component (PCS) z-scores by 0.75 (95% confidence interval [CI]: –1.41 to –0.09) and 1.5 standard deviations (95% CI: –2.43 to –0.56) respectively. Delay of 14 or more days was associated with a worsening of the lower extremity (Move) subsection of the MFA by 18.6 points (95% CI: 3.3 to 33.8). Delay to surgery was associated with a significantly higher risk of poor reduction among those with available radiographic follow-up (n = 67). Delay of 14 days or more was associated with a 5 times (95% CI: 1.04 to 23.99) greater risk of a postoperative step or gap over 2 mm. Delay to surgery was associated with an increase in thrombotic complications. In those patients who were diagnosed with a pulmonary embolism, the mean delay was 11.3 days versus 7.3 days for the rest of the cohort (P = 0.01). For patients with a deep vein thrombosis, average delay was 14.1 days versus 7.1 days (P = 0.01)
Conclusion and Significance: Delay to surgery is associated with worsening functional outcome scores after as little as 7 days from injury. After 14 days of delay, functional outcomes deteriorate further and radiographic outcomes are negatively influenced. Increased delay also increases risk of thrombotic events. These conclusions underscore the importance of timely treatment for displaced acetabular fractures. Local and regional trauma systems should be established to ensure proper treatment is available before negatively affecting patient results.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• 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. Δ OTA Grant.