Evaluation of decision-making in the treatment of acetabular fractures

Abstract

• Treatment of acetabular fractures is challenging and risky, especially when surgery is performed. Yet, stability and congruity of the hip joint need to be achieved to ensure earlymobilization, painlessness, and good function. Therefore, coming up with an accuratedecision, whether surgical treatment is indicated or not, is the key to successful therapy.• Data from the German pelvic Trauma Registry (n = 4213) was evaluated retrospectively,especially regarding predictors for surgery. Furthermore, a logistic regression model withsurgical treatment as the dependent variable was established.• In total, 25.8% of all registered patients suffered from an acetabular fracture and 61.9%of them underwent surgery. The fracture classification is important for the indication ofsurgical therapy. Anterior wall fractures were treated surgically in 10.2%, and posteriorcolumn plus posterior wall fractures were operated on in 90.2%. Also, larger fracture gapswere treated surgically more often than fractures with smaller gaps (>3 mm 84.4%, <1mm 20%). In total, 51.4% of women and 66.0% of men underwent surgery. Apart fromthe injury severity score (ISS), factors that characterize the overall picture of the injury wereof no importance for the indication of a surgical therapy (isolated pelvic fracture: 62.0%,polytrauma: 58.8%). The most frequent reason for non-operative treatment was ‘minimaldisplacement’ in 42.2%.• Besides fracture classification and fracture characteristics, no factors characterizing theoverall injury, except for the ISS, and unexpectedly gender, are important for making atreatment decision. Further studies are needed to determine the relevance of these factors,and whether they should be used for the decision-making process, in particular surgeonswith less experience in pelvic surgery, can orient themselves to