Clinical efficacy and its influencing factors of surgical treatment for T-shaped associated with posterior wall acetabular fractures using combined surgical approaches

BACKGROUND: The objective of this study was to evaluate the outcomes of surgical treatment for T-shaped associated with posterior wall acetabular fractures using combined surgical approaches and its influencing factors. METHODS: Between January 2009 and June 2018, a total of 21 patients with T-shaped acetabular fractures involving posterior wall were treated with combined approaches. The combined approaches were a combination of the Kocher-Langenbeck (KL) approach and the anterior approach (Stoppa or Ilioinguinal). The acetabular fractures in this study were divided into two groups respectively according to surgical approach and surgical timing: KL + Ilioinguinal (IL) approaches and KL + Stoppa approaches, early surgery and late surgery. RESULTS: 13 cases were treated within 14 days of injury. 15 cases were treated using the KL + Stoppa approaches and remaining 6 cases were treated using the KL + IL approaches. Anatomical and imperfect reduction were achieved in 12 cases (57.1%) with excellent to good clinical outcome in 42.9% of cases. Early surgery had a statistically significant improvement over late surgery in terms of quality of reduction and clinical outcomes. In the early surgery, the incidence of preoperative chest and abdomen injuries and postoperative deep vein thrombosis was significantly lower than that of the late surgery. There was no statistical difference between the KL + IL approaches and KL + Stoppa approaches in the demographics, preoperative associated injuries, quality of reduction, clinical outcomes and postoperative complications. CONCLUSIONS: The results of this study indicate that T-shaped associated with posterior wall acetabular fractures are difficult to treat surgically. Early surgery can improve the quality of fracture reduction, promote the recovery of hip function, and decrease the incidence of postoperative deep vein thrombosis. The main factor that affects surgical timing is the presence of preoperative chest and abdominal injuries. Compared with the KL + IL approaches, the KL combined with Stoppa approach can not significantly improve the clinical outcomes of such acetabular fractures.