Surgical treatment for combined acetabulum and pelvic ring injuries: What are the factors that make acetabulum reduction difficult?

Abstract text (incl. references and figure legends)

Introduction: Combined acetabulum and pelvic ring injuries are not rare. However, despite the complexity of the fracture morphology, there is no protocol for surgical treatment, and reduction of the acetabulum is often difficult. So, this study is to clarify the factors that make it difficult to reduce the acetabulum articular surface in combined acetabulum and pelvic ring injuries.
Material & Methods: Records of 14 patients admitted with a diagnosis of combined acetabulum and pelvic ring injuries were reviewed retrospectively. Postoperative reduction of the acetabulum articular surface was evaluated based on Matta's criteria. We divided the patients into two groups (the good group and the poor group) and compared the factors that led to the poor reduction. The classification of pelvic ring/acetabular fractures (AO and Judet-Letournel classification) and injury type of posterior pelvic lesion were compared between groups.
Results: There were 11 patients in the good group and 3 patients in the poor group. According to the AO classification of pelvic injury, there were 9 B type and 2 C type injuries in the good group, and 1 B type and 2 C type in the poor group. According to the Judet-Letournel classification of acetabulum injury, there were 5 elementary fractures and 6 associated fractures in the good group, and all fractures in the poor group were associated fractures. In the poor group, all cases were combined with sacral fractures and were injured on bilateral posterior lesion of the pelvic ring.
Conclusion: In addition to the complex fracture morphology of both the pelvic ring and acetabulum, sacral fractures and damage to bilateral posterior pelvic ring are considered to be the factors for poor reduction. Those sacral fractures tend to be poorly reduced by indirect reduction and they might lead to malreduction of the acetabulum.
References: 1, Tiziani S. Injury. 2021;52:2712-2718.
2, T Suzuki. J Orthop Trauma. 2010;24:303–308.

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