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Delayed Fixation of Acetabular Fractures Affects Functional Outcomes and Health-Related Quality of Life, Not Just Quality of Reduction

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Abstract

Background

Delayed operative fixation of acetabular fractures remains a major problem in many parts of the world. No previous studies have reported the effect of fixation delay on health-related quality of life (HRQOL). We aimed to investigate the effect of delayed operative fixation of acetabular fractures on health-related quality of life, EuroQol-5 Dimension questionnaire (EQ-5D), and other related outcomes.

Methods

We retrospectively analysed 117 patients who underwent open reduction internal fixation for displaced acetabular fractures between 2014 and 2021. Patients were divided into groups based on the admission-to-surgery time (interval between injury and definitive surgery): 1–14, 15–21, and >21 days. Patients were analysed for associations between admission-to-surgery time and postoperative outcomes, including operative time, estimated blood loss, blood transfusion, postoperative complication, and quality of reduction. Eighty-five patients with a mean follow-up time of 3.94 ± 1.84 years were analysed for the association between admission-to-surgery time and conversion to total hip arthroplasty, the Modified Merle d’Aubigné and Postel score, EQ-5D score, ability to sit cross-legged, and ability to sit squat. Multivariable linear regression was used for continuous outcomes and logistic regression for categorical outcomes associated with delayed operative fixation.

Results

An admission-to-surgery time > 14 days was associated with significantly higher blood loss [785 mL (236–1335), p = 0.006]. For associated fractures, an admission-to-surgery time > 21 days increased the risk of poor reduction [odds ratio (OR), 5.21 (1.42–19.11), p = 0.013]. Further, admission-to-surgery time > 21 days was associated with poor Modified Merle d’Aubigné and Postel scores [OR, 8.46 (1.48–48.29), p = 0.016], EQ-5D pain domain [OR, 3.55 (1.15–11), p = 0.028], and EQ-5D usual activity domain [OR, 4.24 (1.28–14), p = 0.018].

Conclusion

Delayed operative fixation of acetabular fractures after 21 days affected the functional outcomes and HRQOL, independent of the reduction status. Surgical interventions and patient referrals should occur at the earliest and within 21 days from the time of injury.

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Data Availability

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.

Code Availability

The code that produces the findings of this study are available on request from the corresponding author.

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Acknowledgements

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Funding

No funds, grants, or other support was received during the study or preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

    Kantapon Dissaneewate

  2. Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

    Kantapon Dissaneewate

  3. Faculty of Medicine Siriraj Hospital, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand

    Thammaphong Khongkanin

  4. Bhumibol Adulyadej Hospital, Bangkok, Thailand

    Rahat Jarayabhand

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  2. Thammaphong Khongkanin
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  3. Rahat Jarayabhand
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Contributions

All authors contributed to the conception and design of the study. Material preparation, data collection and analysis were performed by KD and TK. The first draft of the manuscript was written by KD, and all the authors commented on the previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Rahat Jarayabhand.

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Conflict of Interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This study was conducted in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Bhumibol Adulyadej hospital institutional review board (25 August 2022/ IRB No. 63/65).

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Consent was waived by the institutional review board, as this was a retrospective study with minimal risk to the participants.

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Not applicable. Our manuscript does not contain any individual patient’s data in any form.

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Dissaneewate, K., Khongkanin, T. & Jarayabhand, R. Delayed Fixation of Acetabular Fractures Affects Functional Outcomes and Health-Related Quality of Life, Not Just Quality of Reduction. JOIO 58, 722–731 (2024). https://doi.org/10.1007/s43465-024-01163-x

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