Achieving anatomic acetabular fracture reduction - When is the best time to operate?

Steven Dailey, Caleb T. Phillips, Joseph M. Radley, Michael T. Archdeacon

Research output: Contribution to journalArticle

Abstract

Objectives: We hypothesize that earlier operative intervention for acetabular fractures improves the probability of achieving an anatomic reduction. Design: Retrospective review. Setting: Academic level I trauma center. Patients/Participants: Six hundred fifty acetabular fractures treated through open reduction and internal fixation (ORIF) between September 2001 and February 2014. Intervention: Acetabular fracture ORIF. Main Outcome Measurements: Reduction quality was assessed through postoperative radiographs. Displacement of ≤1 mm was considered an anatomic reduction, 2-3 mm imperfect, and >3 mm poor. Results: Anatomic reductions were observed in 85% (n 553) of cases, imperfect reductions in 11% (n 74) of cases, and poor reductions in 4% (n 23) of cases. Patients with anatomic reductions had significantly shorter times from injury to ORIF [odds ratio (OR) interval] (median, 3 d) when compared with either imperfect (median, 4.5 days, P 0.02) or poor reductions (median, 7 days, P < 0.001) reductions. The OR interval of imperfect reductions was also significantly shorter than that of poor reductions (P 0.02). Logistic regression analysis demonstrated that OR interval had an effect of -0.12, meaning that the log odds of anatomic reduction decreases by 0.12 with each day from injury to ORIF. Conclusion: The interval from injury to operative fixation of acetabular fractures affects reduction quality. Earlier intervention improves the probability of achieving an anatomic reduction; therefore, ORIF should be performed as early as possible, provided the patient is optimized for surgery. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)426-431
Number of pages6
JournalJournal of orthopaedic trauma
Volume30
Issue number8
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

Fingerprint

Fracture Fixation
Odds Ratio
Wounds and Injuries
Trauma Centers
Logistic Models
Regression Analysis

Keywords

  • acetabulum
  • ORIF
  • reduction quality
  • surgical timing

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Achieving anatomic acetabular fracture reduction - When is the best time to operate? / Dailey, Steven; Phillips, Caleb T.; Radley, Joseph M.; Archdeacon, Michael T.

In: Journal of orthopaedic trauma, Vol. 30, No. 8, 01.08.2016, p. 426-431.

Research output: Contribution to journalArticle

Dailey, Steven ; Phillips, Caleb T. ; Radley, Joseph M. ; Archdeacon, Michael T. / Achieving anatomic acetabular fracture reduction - When is the best time to operate?. In: Journal of orthopaedic trauma. 2016 ; Vol. 30, No. 8. pp. 426-431.
@article{f03c061690ca4122a6b90953b820ac91,
title = "Achieving anatomic acetabular fracture reduction - When is the best time to operate?",
abstract = "Objectives: We hypothesize that earlier operative intervention for acetabular fractures improves the probability of achieving an anatomic reduction. Design: Retrospective review. Setting: Academic level I trauma center. Patients/Participants: Six hundred fifty acetabular fractures treated through open reduction and internal fixation (ORIF) between September 2001 and February 2014. Intervention: Acetabular fracture ORIF. Main Outcome Measurements: Reduction quality was assessed through postoperative radiographs. Displacement of ≤1 mm was considered an anatomic reduction, 2-3 mm imperfect, and >3 mm poor. Results: Anatomic reductions were observed in 85{\%} (n 553) of cases, imperfect reductions in 11{\%} (n 74) of cases, and poor reductions in 4{\%} (n 23) of cases. Patients with anatomic reductions had significantly shorter times from injury to ORIF [odds ratio (OR) interval] (median, 3 d) when compared with either imperfect (median, 4.5 days, P 0.02) or poor reductions (median, 7 days, P < 0.001) reductions. The OR interval of imperfect reductions was also significantly shorter than that of poor reductions (P 0.02). Logistic regression analysis demonstrated that OR interval had an effect of -0.12, meaning that the log odds of anatomic reduction decreases by 0.12 with each day from injury to ORIF. Conclusion: The interval from injury to operative fixation of acetabular fractures affects reduction quality. Earlier intervention improves the probability of achieving an anatomic reduction; therefore, ORIF should be performed as early as possible, provided the patient is optimized for surgery. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.",
keywords = "acetabulum, ORIF, reduction quality, surgical timing",
author = "Steven Dailey and Phillips, {Caleb T.} and Radley, {Joseph M.} and Archdeacon, {Michael T.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1097/BOT.0000000000000576",
language = "English (US)",
volume = "30",
pages = "426--431",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Achieving anatomic acetabular fracture reduction - When is the best time to operate?

AU - Dailey, Steven

AU - Phillips, Caleb T.

AU - Radley, Joseph M.

AU - Archdeacon, Michael T.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objectives: We hypothesize that earlier operative intervention for acetabular fractures improves the probability of achieving an anatomic reduction. Design: Retrospective review. Setting: Academic level I trauma center. Patients/Participants: Six hundred fifty acetabular fractures treated through open reduction and internal fixation (ORIF) between September 2001 and February 2014. Intervention: Acetabular fracture ORIF. Main Outcome Measurements: Reduction quality was assessed through postoperative radiographs. Displacement of ≤1 mm was considered an anatomic reduction, 2-3 mm imperfect, and >3 mm poor. Results: Anatomic reductions were observed in 85% (n 553) of cases, imperfect reductions in 11% (n 74) of cases, and poor reductions in 4% (n 23) of cases. Patients with anatomic reductions had significantly shorter times from injury to ORIF [odds ratio (OR) interval] (median, 3 d) when compared with either imperfect (median, 4.5 days, P 0.02) or poor reductions (median, 7 days, P < 0.001) reductions. The OR interval of imperfect reductions was also significantly shorter than that of poor reductions (P 0.02). Logistic regression analysis demonstrated that OR interval had an effect of -0.12, meaning that the log odds of anatomic reduction decreases by 0.12 with each day from injury to ORIF. Conclusion: The interval from injury to operative fixation of acetabular fractures affects reduction quality. Earlier intervention improves the probability of achieving an anatomic reduction; therefore, ORIF should be performed as early as possible, provided the patient is optimized for surgery. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

AB - Objectives: We hypothesize that earlier operative intervention for acetabular fractures improves the probability of achieving an anatomic reduction. Design: Retrospective review. Setting: Academic level I trauma center. Patients/Participants: Six hundred fifty acetabular fractures treated through open reduction and internal fixation (ORIF) between September 2001 and February 2014. Intervention: Acetabular fracture ORIF. Main Outcome Measurements: Reduction quality was assessed through postoperative radiographs. Displacement of ≤1 mm was considered an anatomic reduction, 2-3 mm imperfect, and >3 mm poor. Results: Anatomic reductions were observed in 85% (n 553) of cases, imperfect reductions in 11% (n 74) of cases, and poor reductions in 4% (n 23) of cases. Patients with anatomic reductions had significantly shorter times from injury to ORIF [odds ratio (OR) interval] (median, 3 d) when compared with either imperfect (median, 4.5 days, P 0.02) or poor reductions (median, 7 days, P < 0.001) reductions. The OR interval of imperfect reductions was also significantly shorter than that of poor reductions (P 0.02). Logistic regression analysis demonstrated that OR interval had an effect of -0.12, meaning that the log odds of anatomic reduction decreases by 0.12 with each day from injury to ORIF. Conclusion: The interval from injury to operative fixation of acetabular fractures affects reduction quality. Earlier intervention improves the probability of achieving an anatomic reduction; therefore, ORIF should be performed as early as possible, provided the patient is optimized for surgery. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

KW - acetabulum

KW - ORIF

KW - reduction quality

KW - surgical timing

UR - http://www.scopus.com/inward/record.url?scp=84961221326&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961221326&partnerID=8YFLogxK

U2 - 10.1097/BOT.0000000000000576

DO - 10.1097/BOT.0000000000000576

M3 - Article

C2 - 26978138

AN - SCOPUS:84961221326

VL - 30

SP - 426

EP - 431

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

IS - 8

ER -