Complications in operative treatment of acetabular fractures

Objective To sum up our clinical experience of managing complications in operative treatment of 46 acetabular fractures in our hospital. Methods 46 cases of acetabular fractures accepted open reduction and internal fixation (ORIF) in our hospital from 1994 to 2004. Skeletal traction was applied for 3 to 4 weeks. Continuous passive motion of the hip joint and the exercise of the femoral quadriceps started on the third postoperative day. Indomethacin was used prophylactically to prevent heterotopic ossification. At first, the patients were confined to bed for 8 weeks, and then partial weight bearing for 8 weeks was recommended. The patients were allowed full weight bearing over the next 8 weeks.For the patients with sciatic nerve injury, nerve nutrition drugs were applied routinely. In order to prevent deep venous thrombosis (DVT), partial anticoagulation with heparin was applied for old and high risky patients following surgery, typically for 3 to 4 weeks. Results In this study, excellent results were reported in 28 cases, good in 9, fair in 5, and poor in 4, the excellent and good rate was 80.4% . Deep infection occurred in only one case which was treated with debridement and lavage. Heterotopic ossification occurred in 11 cases. Of the 6 patients with sciatic nerve injury before surgery, 4 experienced improvement. In this group 3 cases suffered from DVT and were given anticoagulation. 2 cases of them recovered and the symptom lasted more than half a year in the remaining one. 6 cases experienced avascular necrosis of the femoral head, and 4 of them accepted total hip arthroplasty (THA). Conclusion For most displaced acetabular fractures, open reduction and internal fixation (ORIF) is still a proper procedure, but care should be taken to prevent associated complications. [