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Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the cl...

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Autores principales: Lin, Sung-Yen, Ho, Cheng-Jung, Liu, Wen-Chih, Chen, Jr-Kai, Tu, Hung-Pin, Lee, Tien-Ching, Chang, Je-Ken, Chen, Chung-Hwan, Lu, Cheng-Chang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180942/
https://www.ncbi.nlm.nih.gov/pubmed/35683631
http://dx.doi.org/10.3390/jcm11113244
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author Lin, Sung-Yen
Ho, Cheng-Jung
Liu, Wen-Chih
Chen, Jr-Kai
Tu, Hung-Pin
Lee, Tien-Ching
Chang, Je-Ken
Chen, Chung-Hwan
Lu, Cheng-Chang
author_facet Lin, Sung-Yen
Ho, Cheng-Jung
Liu, Wen-Chih
Chen, Jr-Kai
Tu, Hung-Pin
Lee, Tien-Ching
Chang, Je-Ken
Chen, Chung-Hwan
Lu, Cheng-Chang
author_sort Lin, Sung-Yen
collection PubMed
description Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes.
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spelling pubmed-91809422022-06-10 Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis Lin, Sung-Yen Ho, Cheng-Jung Liu, Wen-Chih Chen, Jr-Kai Tu, Hung-Pin Lee, Tien-Ching Chang, Je-Ken Chen, Chung-Hwan Lu, Cheng-Chang J Clin Med Article Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes. MDPI 2022-06-06 /pmc/articles/PMC9180942/ /pubmed/35683631 http://dx.doi.org/10.3390/jcm11113244 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lin, Sung-Yen
Ho, Cheng-Jung
Liu, Wen-Chih
Chen, Jr-Kai
Tu, Hung-Pin
Lee, Tien-Ching
Chang, Je-Ken
Chen, Chung-Hwan
Lu, Cheng-Chang
Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis
title Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis
title_full Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis
title_fullStr Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis
title_full_unstemmed Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis
title_short Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis
title_sort predicting the poor clinical and radiographic outcomes after the anatomical reduction and internal fixation of posterior wall acetabular fractures: a retrospective analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180942/
https://www.ncbi.nlm.nih.gov/pubmed/35683631
http://dx.doi.org/10.3390/jcm11113244
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