Clarke-Jenssen, J Bone Joint Surg Am 2016 - Long-Term Survival of the Native Hip after a Minimally Displaced, Nonoperatively Treated Acetabular Fracture

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Long-Term Survival of the Native Hip after a Minimally Displaced, Nonoperatively Treated Acetabular Fracture

Clarke-Jenssen, Madsen, et al.·J Bone Joint Surg Am·2016·30 citations·Prospective cohort

Background

Few studies have evaluated the long-term results for nonoperatively treated acetabular fractures. The purpose of this study was to describe the long-term survival of the native acetabulum as well as the clinical and radiographic outcome for patients with nonoperatively treated acetabular fractures.

Methods

All patients with acetabular fractures are prospectively registered in our acetabular fracture database and followed up at regular intervals for up to 20 years.
We identified 236 patients (237 fractures) who had been treated nonoperatively between 1994 and 2004; 51 patients with incomplete data were excluded.
For the survival analysis, 186 fractures with an average follow-up of 9 years (range, 1 to 20 years) were included.
For the long-term clinical outcome, 104 patients with an average follow-up of 12.1 years (range, 9 to 20 years) were included.

Results

The 10-year survival of the native hips was 94% (111 hips were at risk).
89 percent of the patients had a good or excellent Harris hip score, and 88% had a good or excellent Merle d'Aubigné and Postel score.
The most important negative predictor for clinical outcome and survival of the hip was a fracture step-off of ≥2 mm measured in the obturator oblique radiograph.

Conclusions

Nonoperative treatment of minimally displaced acetabular fractures yields good to excellent long-term results. For patients with a questionable indication for fracture surgery, oblique radiographs (Judet views) are a helpful tool in the decision-making process, as a fracture step-off of ≥2 mm is a strong predictor for a poor clinical and radiographic result at 10 years.

Level of evidence: Prognostic Level II. Copyright remains with the authors and publisher.

Long-Term Survival of the Native Hip after a Minimally Displaced, Nonoperatively Treated Acetabular Fracture

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Long-Term Survival of the Native Hip after a Minimally Displaced, Nonoperatively Treated Acetabular Fracture

Clarke-Jenssen, Madsen, et al.·J Bone Joint Surg Am·2016·30 citations·Prospective cohort

Background

Few studies have evaluated the long-term results for nonoperatively treated acetabular fractures. The purpose of this study was to describe the long-term survival of the native acetabulum as well as the clinical and radiographic outcome for patients with nonoperatively treated acetabular fractures.

Methods

All patients with acetabular fractures are prospectively registered in our acetabular fracture database and followed up at regular intervals for up to 20 years.
We identified 236 patients (237 fractures) who had been treated nonoperatively between 1994 and 2004; 51 patients with incomplete data were excluded.
For the survival analysis, 186 fractures with an average follow-up of 9 years (range, 1 to 20 years) were included.
For the long-term clinical outcome, 104 patients with an average follow-up of 12.1 years (range, 9 to 20 years) were included.

Results

The 10-year survival of the native hips was 94% (111 hips were at risk).
89 percent of the patients had a good or excellent Harris hip score, and 88% had a good or excellent Merle d'Aubigné and Postel score.
The most important negative predictor for clinical outcome and survival of the hip was a fracture step-off of ≥2 mm measured in the obturator oblique radiograph.

Conclusions

Nonoperative treatment of minimally displaced acetabular fractures yields good to excellent long-term results. For patients with a questionable indication for fracture surgery, oblique radiographs (Judet views) are a helpful tool in the decision-making process, as a fracture step-off of ≥2 mm is a strong predictor for a poor clinical and radiographic result at 10 years.

Level of evidence: Prognostic Level II. Copyright remains with the authors and publisher.

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