OTA 2002 Posters

Associated Both-Column Acetabular Fracture: Long-term Functional Outcome of Nonoperative versus Operative Management

Cornelia M. Borkhoff, MSc; Paul Halliwell, MD; Julian Owen, MD; Susan B. Jaglal, PhD; Hans J. Kreder, MD, FRCS(C); Marvin Tile, MD; Department of Orthopaedic Surgery, Sunnybrook & Women's College Health and Science Centre, Toronto, Ontario, Canada

Purpose: The purpose of this study was to compare long-term functional outcome of nonoperatively managed and surgically treated patients who sustained an associated both-column acetabular fracture.

Methods: Sixty-nine (14 nonoperatively managed and 55 surgically treated) patients who sustained an associated both-column acetabular fracture between September 1978 and June 1997 were identified by using a trauma database at a level 1 trauma center. Injury and comorbid information, treatment details, and complications were gathered from the hospital chart by using a standardized data abstraction form. Patient function was measured by using the musculoskeletal functional assessment (MFA) and the SF-36 questionnaires. Relevant radiographs were reviewed by an observer blinded to functional outcome.

Results: Although the nonoperatively managed patients were older on average (P<0.001), there was no difference in sex, hospital stay, or time to assessment between the two groups. Of the 14 nonoperatively managed patients, 8 were male, the mean age at time of injury was 48 ± 13 years, the mean length of hospital stay was 27 days (range, 2 to 77), and the mean length of follow-up was 8.1 years (range, 2.3 to 18.8). Correspondingly, of the 55 surgically treated patients, 30 were male, the mean age at time of injury was 35 ± 13 years, the mean length of hospital stay was 23 days (range, 4 to 94), and the mean length of follow-up was 7.1 years (range, 2.0 to 20.6). Of the patients managed nonoperatively, 86% had at least two comorbidities, such as cardiac disease or diabetes, and 0% had 0 comorbidities. This compared to 64% and 15% in the surgical group, respectively. We found no difference in the mean overall MFA scores between the nonoperatively managed (24.3 ± 13.4) and the surgically treated (29.4 ± 22.6) groups (P = 0.28), nor in the scores for 8 of the 10 subscales. However, the mean scores for the nonoperatively managed group compared with those treated surgically were significantly lower (better) in the self-care (5.2 ± 7.4 vs. 13.0 ± 18.7, P<0.05) and employment (3.6 ± 13.4 vs. 15.9 ± 29.4, P<0.05) categories respectively. With respect to the severity of the acetabular injury, there was no difference in communution or marginal impaction, but those fractures treated surgically had a greater proportion with intraarticular fragments; 46% of patients treated surgically had secondary congruence.

Discussion: We found no difference in functional outcome between nonoperatively managed and surgically treated patients who sustained an associated both-column acetabular fracture, and there is some suggestion of a more favorable outcome for those patients managed nonoperatively.

Conclusions: The results of this study support the need for a prospective study involving the collection of clinical, radiological, and functional outcomes. If prospective data confirm our findings, the risks of internal fixation of this fracture pattern will not be justifiable.