Acetabular fractures: epidemiological, lesional, therapeutic and evolutionary aspects

Abstract

Background: Fractures of the acetabulum are serious because they affect a deep, load-bearing joint that is difficult to repair surgically at first. They occur in a context of polytrauma. The aim of our work is to study the epidemiological, lesional, therapeutic and evolutionary aspects of acetabulum fractures. Methods: This is a 5-year retrospective study from January 2012 to December 2016 including 45 patients treated for acetabulum fracture. Results: 45 patients including 38 men and 7 women with a mean age of 36 years (extremes 18 and 74). The circumstances of occurrence were dominated by road traffic accidents with 42 cases (93.3%). According to the Judet-Letournel classification, we observed 28 elementary fractures (16 posterior wall fractures, 11 posterior column fractures, 1 anterior column fracture) and 17 complex fractures (7 posterior column and posterior wall fractures, 6 transverse and posterior wall fractures, 3 posterior and anterior column fractures, 1 anterior column and posterior hemi-transverse fracture). The association of a dislocation with an acetabulum fracture was found in 32 cases. Associated lesions (fractures) were observed in 23 patients. One case of associated TCE was noted. Treatment was orthopedic in 18 patients, surgical in 18 patients and functional in 9 patients. According to the Matta criteria we obtained after treatment 46.7% good reduction, 51.1% satisfactory and 2.2% unsatisfactory reduction. According to the Postel- Merle D'Aubigné rating, 16 patients obtained excellent results with overall 93.3% satisfactory results. The complications found were coxarthrosis (15 cases), para-articular ossification (2 cases) and vicious callus (1 case). Conclusions: The treatment of acetabulum fractures depends on the type of fracture, the age and activities of the patients. Orthopedic, surgical as well as functional treatment can give good acetabular reconstructions and functional results.