Abstract
Background
Treatment of the transverse acetabular fracture is known to have worse results than other fracture types, although this fracture belongs to the elementary fracture group. The operative results of the transverse acetabular fracture, however, have not been well documented. To determine the results and factors that affect the choice of operative treatment for transverse acetabular fractures, we retrospectively reviewed 15 cases of transverse fracture.
Methods
A total of 15 patients had a transverse fracture, with an average follow-up period of 43 months; there were 8 patients with and 7 without a posterior wall fracture. There were 11 men and 4 women, with a mean age of 46.6 years. In seven cases there was also comminution of the weight-bearing dome. The surgical approaches used were the anterior ilioinguinal approach in 4 patients, the posterior approach in 10 patients, and the combined approach in 1 patient. Postoperative radiographic results were evaluated by Matta’s criteria. Final clinical results were evaluated by a modified Merle d’Aubigne scoring system.
Results
All of the fractures healed. The average time for fracture healing was 17.5 weeks. Postoperative radiology revealed six cases of anatomical reduction, five cases of imperfect reduction, and four cases of poor reduction. According to the clinical results, nine patients had satisfactory results (three excellent, six good), and six had unsatisfactory results (three fair, three poor). Regarding complications, there were four cases of traumatic osteoarthritis and three of heterotopic ossification. The patients with an anatomical reduction had a higher satisfactory result rate. Comminution of the transverse fracture seemed to have an adverse influence on the postoperative radiologic result as well as a correlation with the development of traumatic arthritis.
Conclusions
Transverse acetabular fractures, if not reduced anatomically, may have a tendency toward traumatic osteoarthritis and poor clinical outcome. Comminution of the dome may portend poor results.
Similar content being viewed by others
References
E Letournel (1980) ArticleTitleAcetabulum fractures: classification and management Clin Orthop 151 81–106 Occurrence Handle7418327
Letournel E, Judet R. Fractures of the acetabulum. 2nd ed. Elson RA, translator/editor. New York: Springer; 1993. p. 63–6, 565–8.
A Kebaish A Roy W Rennie (1991) ArticleTitleDisplaced acetabular fractures: long term follow-up J Trauma 31 1539–42 Occurrence Handle10.1097/00005373-199111000-00014 Occurrence Handle1:STN:280:DyaK38%2Fks1ahtQ%3D%3D Occurrence Handle1942178
JM Matta (1996) ArticleTitleFractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury J Bone Joint Surg Am 78 1632–45 Occurrence Handle1:STN:280:DyaK2s%2FovVGluw%3D%3D Occurrence Handle8934477
DC Mears JH Velyvis CP Chang (2003) ArticleTitleDisplaced acetabular fractures managed operatively: indicators of outcome Clin Orthop 407 173–86 Occurrence Handle10.1097/00003086-200302000-00026 Occurrence Handle12567145
MS Vrahas KK Widding KA Thomas (1999) ArticleTitleThe effects of simulated transverse, anterior column, and posterior column fractures of the acetabulum on the stability of the hip joint J Bone Joint Surg Am 81 966–74 Occurrence Handle1:STN:280:DyaK1MzlsFSrsA%3D%3D Occurrence Handle10428128
JM Matta LM Anderson HC Epstein P Hendricks (1986) ArticleTitleFractures of the acetabulum. A retrospective analysis Clin Orthop 205 230–40 Occurrence Handle3698382
AF Brooker JW Bowerman RA Robinson LH Riley SuffixJr (1973) ArticleTitleEctopic ossification following total hip replacement: incidence and a method of classification J Bone Joint Surg Am 55 1629–32 Occurrence Handle1:STN:280:DyaE2M7hsVylsA%3D%3D Occurrence Handle4217797
GF Pennal J Davidson H Garside J Plewes (1980) ArticleTitleResults of treatment of acetabular fractures Clin Orthop 151 115–23 Occurrence Handle7418294
M Heeg HJ Oostvogel HJ Klasen (1987) ArticleTitleConservative treatment of acetabulum fractures: the role of the weight- bearing dome and anatomic reduction in the ultimate results J Trauma 27 555–9 Occurrence Handle10.1097/00005373-198705000-00016 Occurrence Handle1:STN:280:DyaL2s7pvVyitg%3D%3D Occurrence Handle3573112
AL Malkani MJ Voor G Rennirt D Helfet D Pedersen T Brown (2001) ArticleTitleIncreased peak contact stress after incongruent reduction of transverse acetabular fractures: a cadaveric model J Trauma 51 704–9 10.1097/00005373-200110000-00013 Occurrence Handle10.1097/00005373-200110000-00013 Occurrence Handle1:STN:280:DC%2BD3Mrls1KrtQ%3D%3D Occurrence Handle11586162
N Shazar RJ Brumback VP Novak SM Belkoff (1998) ArticleTitleBiomechanical evaluation of transverse acetabular fracture fixation Clin Orthop 352 215–22 Occurrence Handle9678050
KA Thomas MS Vrahas JW Noble SuffixJr CM Bearden JS Reid (1997) ArticleTitleEvaluation of hip stability after simulated transverse acetabular fractures Clin Orthop 340 244–56 Occurrence Handle10.1097/00003086-199707000-00032 Occurrence Handle9224263
AM Saterbak JL Marsh JV Nepola EA Brandser T Turbett (2000) ArticleTitleClinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns J Orthop Trauma 14 230–7 10.1097/00005131-200005000-00002 Occurrence Handle10.1097/00005131-200005000-00002 Occurrence Handle1:STN:280:DC%2BD3M%2FjtFegtQ%3D%3D Occurrence Handle10898194
BR Moed SE Carr KI Gruson JT Watson JG Craig (2003) ArticleTitleComputed tomography assessment of fractures of the posterior wall of the acetabulum J Bone Joint Surg Am 85 512–22 Occurrence Handle12637440
J Borrelli SuffixJr C Goldfarb L Catalano BA Evanoff (2002) ArticleTitleAssessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs J Orthop Trauma 16 449–56 10.1097/00005131-200208000-00001 Occurrence Handle10.1097/00005131-200208000-00001 Occurrence Handle12172273
SA Olson JM Matta (1993) ArticleTitleThe computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report) J Orthop Trauma 7 402–13 Occurrence Handle10.1097/00005131-199310000-00002 Occurrence Handle1:STN:280:DyaK2c%2Fks1Wjtg%3D%3D Occurrence Handle8229376
JK Chang SS Gill RD Zura WR Krause GJ Wang (2001) ArticleTitleComparative strength of three methods of fixation of transverse acetabular fractures Clin Orthop 392 433–41 Occurrence Handle10.1097/00003086-200111000-00057 Occurrence Handle11716419
T Sawaguchi TD Brown HE Rubash DC Mears (1984) ArticleTitleStability of acetabular fractures after internal fixation: a cadaveric study Acta Orthop Scand 55 601–5 Occurrence Handle1:STN:280:DyaL2M7hvVaitQ%3D%3D Occurrence Handle6524325 Occurrence Handle10.3109/17453678408992404
Author information
Authors and Affiliations
About this article
Cite this article
Oh, CW., Kim, PT., Park, BC. et al. Results after operative treatment of transverse acetabular fractures. J Orthop Sci 11, 478–484 (2006). https://doi.org/10.1007/s00776-006-1045-6
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00776-006-1045-6