Sat., 10/16/10 Pelvis & Spine, Paper #78, 3:36 pm OTA-2010
Outcome of Posterior Wall Fractures of the Acetabulum Treated Nonoperatively after Diagnostic Screening by Dynamic Stress Examination under Anesthesia
Charles S. Grimshaw, MD; Berton R. Moed, MD;
St. Louis University School of Medicine, St. Louis, Missouri, USA
Purpose: Dynamic stress fluoroscopy under general anesthesia has been advocated as a clinical measure of hip stability and congruence in posterior wall acetabular fractures. Open reduction and internal fixation is indicated if the joint is shown to be unstable, while nonoperative management is selected if the joint is found to be stable. However, outcome of hip function after using nonoperative treatment based on this diagnostic examination has yet to be documented. The purpose of this study was to establish the predictive value of dynamic stress fluoroscopic examination under general anesthesia for these fractures by evaluating functional and radiographic outcome after nonoperative treatment of fractures found to be stable by this examination.
Methods: 21 consecutive patients shown to have stable hip joints after dynamic stress fluoroscopy under general anesthesia for an isolated posterior wall fracture were treated nonoperatively. Three patients were lost to follow-up, leaving 18 for study. At follow-up, patients underwent clinical and/or radiographic evaluation. Patients were evaluated radiographically for hip joint congruence and posttraumatic arthritis. Hip function was determined using the modified Merle d’Aubigné clinical score.
Results: Clinical follow-up was obtained on all 18 available patients at a minimum of 2 years (mean 40 months), with an average modified Merle d’Aubigne score of very good and no one having a less than good clinical outcome. 15 of these 18 patients had radiographic evaluation at a minimum of 2 years (mean 41 months), demonstrating a congruent joint with a normal joint space and no evidence of posttraumatic arthritis. Of the three patients not having final follow-up radiographs, two were incarcerated at the time of clinical evaluation, preventing radiographic examination. The third patient was completely asymptomatic but refused follow-up radiographs.
Conclusions: Hip joint stability determined by dynamic stress fluoroscopy under general anesthesia after isolated posterior wall acetabular fracture is predictive of maintained hip joint congruity, excellent radiographic outcome, and a good to excellent clinical outcome with nonoperative treatment.
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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. Δ OTA Grant.