title: Does early fixation of posterior wall acetabular fractures lead to increased blood loss?
abstract: OBJECTIVE
  Controversy exists regarding the ideal timing of acetabular fracture surgery. Surgery within the first 24 hours might put patients at risk for increased blood loss; however, early treatment might facilitate fracture reduction and patient mobilization. The purpose of this study was to determine whether early surgery for posterior wall acetabular fractures results in higher intraoperative blood loss.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I academic trauma center.
  
  
  METHODS
  A 1-year retrospective review of 49 consecutive posterior wall acetabular fractures from a single Level I trauma center. Outcome variables were analyzed with t tests, Pearson correlation coefficient, and multiple linear regression analysis.
  
  
  METHODS
  Surgery for posterior wall acetabular fractures.
  
  
  METHODS
  Estimated blood loss (EBL), preoperative and postoperative hematocrit levels, and intraoperative and postoperative blood product requirements as a function of the timing of surgery.
  
  
  RESULTS
  No difference in EBL was shown between the fractures fixed within 24 hours of injury (mean = 644 mL) and those fixed later (573 mL, P = 0.50). No difference was observed when analyzing timing of surgery as a continuous variable (P = 0.45) or other outcome variables. A post hoc power analysis demonstrated that our sample could detect a difference in EBL of 166 mL.
  
  
  CONCLUSIONS
  Our study suggests that posterior wall fractures might be a subset of acetabular fractures that can be treated immediately without increased risk of excessive blood loss. It should be emphasized that our findings should not be applied to other more complex types of fractures of the acetabulum.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Furey
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Karp
authors.forename: Robert V
authors.initials: RV
authors.lastname: OʼToole
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D061345:Early Medical Intervention; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies; D013997:Time Factors