This 2005 meta-analysis pooled 34 studies and 3670 operatively treated displaced acetabular fractures to establish benchmark complication and functional outcome rates. It evaluates the Letournel classification, surgical approaches, reduction quality, and late complications including OA, HO, and AVN. The central question: what factors actually drive outcomes in these complex injuries?
The single number to anchor your practice: residual displacement >2 mm triples the OA rate (43.5% vs 13.2%). Every intraoperative decision — approach selection, reduction sequence, implant positioning — should be evaluated against whether it gets you to ≤2 mm.
When you see a posterior acetabular fracture-dislocation, counsel the patient upfront: sciatic nerve injury risk is 40%, AVN risk is 9.2%. These are not rare complications — they are expected co-injuries that require active surveillance.
Approach selection has direct complication consequences. The iliofemoral approach delivers 23.6% Brooker III/IV HO. Reserve it for cases that genuinely require it, and consider HO prophylaxis (indomethacin or local radiation) when extensile exposure is unavoidable.
Timing matters. Surgery delayed beyond 11 days yields significantly fewer anatomical reductions. Get these patients to a pelvic reconstruction center early — tertiary referral is not optional.
This 2005 meta-analysis pooled 34 studies and 3670 operatively treated displaced acetabular fractures to establish benchmark complication and functional outcome rates. It evaluates the Letournel classification, surgical approaches, reduction quality, and late complications including OA, HO, and AVN. The central question: what factors actually drive outcomes in these complex injuries?
The single number to anchor your practice: residual displacement >2 mm triples the OA rate (43.5% vs 13.2%). Every intraoperative decision — approach selection, reduction sequence, implant positioning — should be evaluated against whether it gets you to ≤2 mm.
When you see a posterior acetabular fracture-dislocation, counsel the patient upfront: sciatic nerve injury risk is 40%, AVN risk is 9.2%. These are not rare complications — they are expected co-injuries that require active surveillance.
Approach selection has direct complication consequences. The iliofemoral approach delivers 23.6% Brooker III/IV HO. Reserve it for cases that genuinely require it, and consider HO prophylaxis (indomethacin or local radiation) when extensile exposure is unavoidable.
Timing matters. Surgery delayed beyond 11 days yields significantly fewer anatomical reductions. Get these patients to a pelvic reconstruction center early — tertiary referral is not optional.