title: Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall.
abstract: We have evaluated the functional, clinical and radiological outcome of patients with simple and complex acetabular fractures involving the posterior wall, and identified factors associated with an adverse outcome. We reviewed 128 patients treated operatively for a fracture involving the posterior wall of the acetabulum between 1982 and 1999. The Musculoskeletal Functional Assessment and Short-Form 36 scores, the presence of radiological arthritis and complications were assessed as a function of injury, treatment and clinical variables. The patients had profound functional deficits compared with the normal population. Anatomical reduction alone was not sufficient to restore function. The fracture pattern, marginal impaction and residual displacement of > 2 mm were associated with the development of arthritis, which related to poor function and the need for hip replacement. It may be appropriate to consider immediate total hip replacement for patients aged > 50 years with marginal impaction and comminution of the wall, since 7 of 13 (54%) of these required early hip replacement.
authors.affiliation: Division of Orthopaedics, Sunnybrook Health Science Centre, and St. Michael's Hospital, Suite MG365, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5. bev.bulmer@sunnybrook.ca
authors.forename: H J
authors.initials: HJ
authors.lastname: Kreder
authors.forename: N
authors.initials: N
authors.lastname: Rozen
authors.forename: C M
authors.initials: CM
authors.lastname: Borkhoff
authors.forename: Y G
authors.initials: YG
authors.lastname: Laflamme
authors.forename: M D
authors.initials: MD
authors.lastname: McKee
authors.forename: E H
authors.initials: EH
authors.lastname: Schemitsch
authors.forename: D J G
authors.initials: DJ
authors.lastname: Stephen
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001168:Arthritis / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006304:Health Status; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology; D010243:Paralysis / Q000601:surgery; D011859:Radiography; D012584:Sciatic Nerve / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome