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Thursday, March 1, 2001

Study correlate ORIF with complications

A retrospective and prospective study of clinical and radiographic outcomes of acetabular fractures after open reduction and internal fixation (ORIF) confirms the correlation of an anatomical reduction with a high likelihood for an excellent or good clinical result, especially in young adults and particularly by a postoperative CT assessment.

The study in poster exhibit 109 also found that in the presence of problematic features such as femoral head trauma or an elderly osteopenic patient with an associated fracture, generally an unfavorable clinical outcome follows an ORIF and thereby creates a therapeutic dilemma.

The study examined the clinical and radiographic results of 424 hips in 411 patients who underwent an open reduction and internal fixation of a displaced acetabular fracture and were followed for an average period of 9.3 years (range, 3 years to 21 years). The mean interval between the injury and surgery was 8 days (range, 0 to 21 days).

By plain radiography, an anatomical reduction was documented in 282 cases (67 percent), an imperfect reduction in 90 (21 percent), a poor reduction in 39 (9 percent), and a column fracture with secondary congruity in 13 (3 percent). For the 231 cases with a postoperative CT scan, there were 104 anatomical reductions (46 percent), 78 imperfect reductions (34 percent), 37 poor reductions (16 percent), and 9 both column fractures with secondary congruity (4 percent). The postoperative CT scans indicated much greater risdual displacement than were evident on plain radiographs.

Associated fractures possessed significantly fewer anatomical reductions than simple fractures (chi square = 31.36, p > 0.001). The quality of the postoperative reductions correlated significantly with the age groups of the patients (chi square = 81.17, p > 0.001), with the least accurate reductions in patients over 70 years (chi square = 32.41, p > 0.001).

For clinical assessments with Harris hip scores, there were 305 (72 percent) excellent and good results and 119 (28 percent) fair and poor results. Excellent or good clinical outcomes were more likely after anatomical or imperfect reductions (chi square = 148.04, p > 0.001).

Certain problematic preoperative radiographic features, including trauma to the femoral head or severe acetabular impaction, greatly compromised the clinical outcome.

The study coauthors are Dana C. Mears, MD, department of orthopaedic surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.; and John H. Velyvis, MD, division of orthopaedic surgery, Albany Medical Center, Albany, N.Y.

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2001 Academy News March 1 Index B

Last modified 20/February/2001 by IS