OUTCOMES OF ACETABULAR FRACTURE RECONSTRUCTION SURGERY: THE TIME-CRITICAL EFFECT OF DELAY

Background Referral to centres with a pelvic service is standard practice for the management of displaced acetabular fractures. Hypothesis The time to surgery: (1) is a predictor of radiological and functional outcome and (2) this varies with the fracture pattern. Methods A retrospective case review of 254 patients over a ten year period with a minimum follow-up of two years. Patients were divided into two groups based on fracture pattern: elementary or associated. ‘Time to surgery’ was analysed as a continuous and a stratified variable. The primary outcome measures were the quality of reduction and functional outcome. Logistic regression analysis was used to test our hypothesis, while controlling for potential confounding variables. Results For elementary fractures, an increase in the time to surgery on one day reduced the odds of an excellent/good functional result by 15% (p = 0.001) and of an anatomical reduction by 18% (p = 0.0001). For associated fractures, the odds of obtaining an excellent/good result were reduced by 19% (p = 0.0001) and an anatomical reduction by 18% (p = 0.0001) per day. When ‘time’ was measured as a categorical variable, an anatomical reduction was more likely if surgery was performed within 15 days (elementary) and five days (associated). An excellent/good functional outcome was more likely when surgery was performed within 15 days (elementary) and ten days (associated). Conclusion The time to surgery is a significant predictor of radiological and functional outcome for both elementary and associated displaced acetabular fractures. The organisation of regional trauma systems must be capable of satisfying these time-critical targets to achieve optimal patient outcome.