Factors affecting the functional outcome of surgically managed displaced acetabular fractures.
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ABSTRACT: Purpose of study
To evaluate the impact of various factors on functional outcome of surgically managed displaced acetabular fractures.Methods
In this prospective study 50 cases of surgically managed displaced acetabular fractures were followed up to a mean of 28.6±4 months (18-48 months). The effect of age, associated injuries, fracture pattern (elementary/associated type), time to surgery (<2 weeks/>2 weeks), accuracy of reduction (anatomical/imperfect/poor), gender and associated hip dislocation on the clinical outcome was evaluated using Harris hip score and modified Postel Merle d'Aubigné score.Results
The mean age was 36.6±11.9 years (range 19-67 years). There were 76% (n=38) males and 24% (n=12) females. 82% (n=41) patients sustained fracture due to motor vehicle accident. 60% of the cases had associated injuries. The mean Harris hip score at final follow-up was 80.96±8.9 and mean modified Merle d'Aubigné and Postel score was 15.1±2.4. The Harris Hip score and modified Postel Merle d'Aubigné score was significantly affected by presence of associated injuries (P=0.0025 and 0.0037 respectively), time to surgery (P=0.0087 and 0.0093 respectively), fracture pattern (P=0.015 and 0.023 respectively), associated hip dislocation (P=0.011 and 0.008 respectively), accuracy of reduction (P<0.05) and age (P<0.05), but gender (P=0.78 and 0.93 respectively) didn't have any significant effect on the clinical outcome.Conclusion
The presence of associated injuries, concomitant hip dislocation, associated type of fracture patterns, elderly age (more than 60 years), sub optimal fracture reduction and delay in surgery beyond 2 weeks are factors that lead to statistically significant suboptimal functional scores.
SUBMITTER: Huda N
PROVIDER: S-EPMC8166661 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThere are several studies on nonunion, but there are no systematic overviews of the current evidence of risk factors for nonunion. The aim of this study was to systematically review risk factors for nonunion following surgically managed, traumatic, diaphyseal fractures.MethodsMedline, Embase, Scopus, and Cochrane were searched using a search string developed with aid from a scientific librarian. The studies were screened independently by two authors using Covidence. We solely included studies with at least ten nonunions. Eligible study data were extracted, and the studies were critically appraised. We performed random-effects meta-analyses for those risk factors included in five or more studies. PROSPERO registration number: CRD42021235213.ResultsOf 11,738 records screened, 30 were eligible, and these included 38,465 patients. Twenty-five studies were eligible for meta-analyses. Nonunion was associated with smoking (odds ratio (OR): 1.7, 95% CI: 1.2-2.4), open fractures (OR: 2.6, 95% CI: 1.8-3.9), diabetes (OR: 1.6, 95% CI: 1.3-2.0), infection (OR: 7.0, 95% CI: 3.2-15.0), obesity (OR: 1.5, 95% CI: 1.1-1.9), increasing Gustilo classification (OR: 2.2, 95% CI: 1.4-3.7), and AO classification (OR: 2.4, 95% CI: 1.5-3.7). The studies were generally assessed to be of poor quality, mainly because of the possible risk of bias due to confounding, unclear outcome measurements, and missing data.ConclusionEstablishing compelling evidence is challenging because the current studies are observational and at risk of bias. We conclude that several risk factors are associated with nonunion following surgically managed, traumatic, diaphyseal fractures and should be included as confounders in future studies.
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Project description:BackgroundSurgery for fixation of olecranon fractures is associated with reoperation, mostly for implant removal. A study of a large cohort of patients treated by many different surgeons allows us to determine if specific techniques or implants are associated with a higher rate of reoperation.Questions/purposesAfter open reduction and internal fixation of isolated olecranon fractures, what factors are associated with (1) reoperation and (2) implant removal?MethodsThree hundred ninety-two adult patients who had operative treatment of a displaced olecranon fracture not associated with other fractures, dislocation, or subluxation at two area hospitals between January 2002 and May 2014 were analyzed to determine factors associated with reoperation. One hundred thirty-eight (35%) patients had plate and screw fixation and 254 (65%) tension band wiring. Nearly 100% of patients with displaced olecranon fractures are currently treated operatively at our hospitals. All patients were followed for at least four months. Two hundred three of the 392 (52%) patients were followed for one year or more. Ninety-nine patients (25%) had a second operation, 92 (93%) at least in part for implant removal (12 for wire migration [3% of all fractures, 12% of reoperations]). We considered patient-related, fracture-related, and implant-related endpoints as possible factors associated with reoperation. With a total sample size of 99 reoperations, an α of 0.05, and an effect size of 0.3, we had 87% power.ResultsReoperation was less common in men (36 [36%], women: 63 [64%]; adjusted odds ratio, 0.32; 95% confidence interval, 0.18-0.56; p < 0.001) and older patients (adjusted odds ratio, 0.75; 95% confidence interval, 0.65-0.87; p < 0.001). Similarly, request for implant removal was less in men (33 [36%], women: 59 [64%], adjusted odds ratio, 0.31; 95% confidence interval, 0.18-0.56; p < 0.001) and older patients (adjusted odds ratio, 0.75; 95% confidence interval, 0.65-0.87; p < 0.001).ConclusionsPatients who have operative fixation of a fracture of the olecranon can be counseled that most patients keep their implants, that only 3% experience implant migration, and that technical factors such as the type or configuration of an implant seem less important than personal factors in determining who requests a second surgery for implant removal.Level of evidenceLevel III, prognostic study.
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