Matta, J Bone Joint Surg Am 1996 - Fractures of the Acetabulum: Accuracy of Reduction and Clinical Results in Patients Managed Operatively within Three Weeks after the Injury
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Fractures of the Acetabulum: Accuracy of Reduction and Clinical Results in Patients Managed Operatively within Three Weeks after the Injury
Matta·J Bone Joint Surg Am·1996·1,396 citations·Retrospective cohort
Matta reviewed how accurately displaced acetabular fractures were reduced when fixed within three weeks of injury, and how the reduction related to the clinical result.
Retrospective review of 262 displaced acetabular fractures in 259 patients at two Los Angeles hospitals, followed a mean of 6 years.
Methods
Design
Retrospective review
Data source
Los Angeles County–University of Southern California Medical Center
Good Samaritan Hospital, Los Angeles
Patients
259 patients with 262 displaced acetabular fractures
Fixed within 21 days of injury
Associated fracture types 79% (Letournel and Judet)
Both‑column fractures most common (35%)
Exposure
Kocher‑Langenbeck approach (112 hips)
Ilioinguinal approach (87 hips)
Extended iliofemoral approach (59 hips)
Kocher‑Langenbeck plus ilioinguinal (4 hips)
Follow-up
Mean 6 years (range 2 to 14) in 255 hips
7 hips with a clear poor result followed under 2 years
An anatomical reduction was strongly associated with an excellent or good clinical result (p = 0.002).
Anatomical reduction was achieved in 96% of simple fracture types vs 64% of associated types, and all 18 poor reductions were associated types.
Anatomical reduction was 74% at 0 to 7 days, 71% at 8 to 14 days and 57% at 15 to 21 days, a trend that was not significant (p = 0.16, or p = 0.06 for 0 to 14 vs 15 to 21 days).
Clinical results were excellent in 40% of hips, good in 36%, fair in 8% and poor in 16%.
Hips with femoral head damage had a lower mean clinical score than those without (14 vs 16 points, p = 0.01).
Fracture pattern, simple or associated, was not significantly related to the clinical result (p = 0.32).
Board pearl
Imperfect reductions (2 to 3 mm) did clearly worse than anatomical ones (0 to 1 mm), so Matta abandoned the term 'satisfactory', which implied up to 3 mm was acceptable.
Matta reduction gradesMatta, J Bone Joint Surg Am 1996
Anatomical
0 to 1 mm of displacement
Imperfect
2 to 3 mm
Poor
More than 3 mm
Surgical secondary congruence
Acetabulum reduced anatomically but the innominate bone displaced, both‑column fractures only
Authors' conclusion
These findings indicate that in many patients who have a complex acetabular fracture the hip joint can be preserved and post-traumatic osteoarthrosis can be avoided if an anatomical reduction is achieved. An increase in the rate of anatomical reduction and a decrease in the rate of operative complications should be the goals of surgeons who treat these fractures.
Matta reviewed how accurately displaced acetabular fractures were reduced when fixed within three weeks of injury, and how the reduction related to the clinical result.
Retrospective review of 262 displaced acetabular fractures in 259 patients at two Los Angeles hospitals, followed a mean of 6 years.
Methods
Design
Retrospective review
Data source
Los Angeles County–University of Southern California Medical Center
Good Samaritan Hospital, Los Angeles
Patients
259 patients with 262 displaced acetabular fractures
Fixed within 21 days of injury
Associated fracture types 79% (Letournel and Judet)
Both‑column fractures most common (35%)
Exposure
Kocher‑Langenbeck approach (112 hips)
Ilioinguinal approach (87 hips)
Extended iliofemoral approach (59 hips)
Kocher‑Langenbeck plus ilioinguinal (4 hips)
Follow-up
Mean 6 years (range 2 to 14) in 255 hips
7 hips with a clear poor result followed under 2 years
An anatomical reduction was strongly associated with an excellent or good clinical result (p = 0.002).
Anatomical reduction was achieved in 96% of simple fracture types vs 64% of associated types, and all 18 poor reductions were associated types.
Anatomical reduction was 74% at 0 to 7 days, 71% at 8 to 14 days and 57% at 15 to 21 days, a trend that was not significant (p = 0.16, or p = 0.06 for 0 to 14 vs 15 to 21 days).
Clinical results were excellent in 40% of hips, good in 36%, fair in 8% and poor in 16%.
Hips with femoral head damage had a lower mean clinical score than those without (14 vs 16 points, p = 0.01).
Fracture pattern, simple or associated, was not significantly related to the clinical result (p = 0.32).
Board pearl
Imperfect reductions (2 to 3 mm) did clearly worse than anatomical ones (0 to 1 mm), so Matta abandoned the term 'satisfactory', which implied up to 3 mm was acceptable.
Matta reduction gradesMatta, J Bone Joint Surg Am 1996
Anatomical
0 to 1 mm of displacement
Imperfect
2 to 3 mm
Poor
More than 3 mm
Surgical secondary congruence
Acetabulum reduced anatomically but the innominate bone displaced, both‑column fractures only
Authors' conclusion
These findings indicate that in many patients who have a complex acetabular fracture the hip joint can be preserved and post-traumatic osteoarthrosis can be avoided if an anatomical reduction is achieved. An increase in the rate of anatomical reduction and a decrease in the rate of operative complications should be the goals of surgeons who treat these fractures.