This retrospective review examines 207 acetabular fractures reconstructed 21-120 days after injury by four surgeons including Letournel. It asks how outcomes and complications compare to early stabilization, and which fracture patterns tolerate delay.
When you cannot operate on an acetabular fracture early, this paper tells you what to expect and how to plan.
Delay to 21-120 days drops good to excellent results from over 80% to 65%, because fracture lines resorb, callus and scar form, and attached muscles contract. That means osteotomy and wedge resection to recreate a spherical acetabulum, and often the extended iliofemoral approach rather than a single Kocher-Langenbeck or ilioinguinal window.
The decision rule for AVN is concrete: a persistently dislocated femoral head carries a 58% necrosis rate, so reduce and hold the head early even if definitive fixation must wait. Pattern matters. Isolated column and posterior column/wall fractures tolerate delay well, while simple wall, transverse/posterior wall, and T-shape fractures fail more often and warrant realistic counseling.
For HO prophylaxis after posterior or extensile approaches, use indomethacin plus low-dose radiation; skip routine prophylaxis with the ilioinguinal approach.
This retrospective review examines 207 acetabular fractures reconstructed 21-120 days after injury by four surgeons including Letournel. It asks how outcomes and complications compare to early stabilization, and which fracture patterns tolerate delay.
When you cannot operate on an acetabular fracture early, this paper tells you what to expect and how to plan.
Delay to 21-120 days drops good to excellent results from over 80% to 65%, because fracture lines resorb, callus and scar form, and attached muscles contract. That means osteotomy and wedge resection to recreate a spherical acetabulum, and often the extended iliofemoral approach rather than a single Kocher-Langenbeck or ilioinguinal window.
The decision rule for AVN is concrete: a persistently dislocated femoral head carries a 58% necrosis rate, so reduce and hold the head early even if definitive fixation must wait. Pattern matters. Isolated column and posterior column/wall fractures tolerate delay well, while simple wall, transverse/posterior wall, and T-shape fractures fail more often and warrant realistic counseling.
For HO prophylaxis after posterior or extensile approaches, use indomethacin plus low-dose radiation; skip routine prophylaxis with the ilioinguinal approach.