This is a multi-surgeon retrospective series of 64 patients who underwent revision surgery for malreduced or failed acetabular fracture fixation. It asks whether reoperation can salvage failed primary open reduction and internal fixation, and what factors predict success.
When a primary acetabular fixation fails, the instinct is pessimism, but this series shows meaningful salvage is possible in the right hands and, critically, in the right timeframe.
The practical decision rule: if you recognize a malreduction or loss of fixation, do not wait. Good/excellent outcomes drop from 57% to 29% as delay crosses 12 weeks, because callus and erosion make anatomic reduction progressively impossible.
Still, results (42% good/excellent) trail primary ORIF (70-85%), so this is not a rescue that erases the cost of a poor index operation. The lesson cuts both ways: get the first operation right, choose the correct approach, and confirm no intraarticular screws.
Recognize the contraindication too. Large weight-bearing femoral head defects or advanced arthrosis push you toward arthroplasty or fusion rather than joint salvage.
This is a multi-surgeon retrospective series of 64 patients who underwent revision surgery for malreduced or failed acetabular fracture fixation. It asks whether reoperation can salvage failed primary open reduction and internal fixation, and what factors predict success.
When a primary acetabular fixation fails, the instinct is pessimism, but this series shows meaningful salvage is possible in the right hands and, critically, in the right timeframe.
The practical decision rule: if you recognize a malreduction or loss of fixation, do not wait. Good/excellent outcomes drop from 57% to 29% as delay crosses 12 weeks, because callus and erosion make anatomic reduction progressively impossible.
Still, results (42% good/excellent) trail primary ORIF (70-85%), so this is not a rescue that erases the cost of a poor index operation. The lesson cuts both ways: get the first operation right, choose the correct approach, and confirm no intraarticular screws.
Recognize the contraindication too. Large weight-bearing femoral head defects or advanced arthrosis push you toward arthroplasty or fusion rather than joint salvage.