Surgical outcomes of the elderly acetabular fractures with superomedial dome impaction

Abstract text (incl. references and figure legends)

Introduction: Dome impaction was known as a poor predictive factor of acetabular fractures (Figure 1), and there has been a debate on the most appropriate treatment in these fractures. The purpose of present study is to investigate the outcome of elderly acetabular fracture according to reduction of impacted dome fragment.

Methods: Patients aged ≥ 60 years with acetabular fracture with dome impaction were retrospectively enrolled. Data for demographics, fracture patterns, and negative predictive factors including dome impaction was collected. Postoperative reduction was measured based on CT scan and were divided into good reduction group (displacement ≤ 3 mm, Figure 2) and poor reduction group (displacement > 3 mm). We compared the outcomes and complications between 2 groups. Subgroup analysis was performed 1) in the patients with dome impaction according to postoperative reduction state and 2) in the patients of good reduction group according to presence of dome impaction. Multivariable analysis was performed to assess to identify prognosis factors.

Results: Among included 54 patients, 20 patients had dome impaction; good reduction group (N = 45) and poor reduction group (N = 9). Good reduction group presented lower radiographic OA (18% vs 77%, P = 0.001), higher HHS score (82.1 vs 68.6, P = 0.022). In a subgroup analysis of patients with dome impaction, good reduction group presented higher good outcome (80% vs 20%, P = 0.031). In comparisons within good reduction group, dome impaction did not influence clinical outcomes. Multivariable analysis presented female sex (OR 19.335; P = 0.040) and poor reduction status (OR 0.014; P = 0.001) were significantly associated with poor outcome.

Conclusion: Elderly acetabular fractures presented favorable outcome when adequate reduction was achieved even when dome impaction was presented. We believe that well-reduced dome impaction could achieve satisfactory outcomes in the elderly acetabular fracture with dome impaction.

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