What is the morbidity and mortality associated with acetabulum fractures?

Updated: Jun 25, 2019
  • Author: David S Levey, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Answer

The events leading to acetabular fracture are of a nature such that contiguous bones, soft tissues, visceral organs, arteries, veins, and nerves are potentially injured. Open and closed fractures may occur, with the former predisposing to cellulitis, soft tissue/myopathic infection, superficial and deep abscesses, osteomyelitis, and vascular compromise and hemorrhage. Neurologic complications are well described.

The National Sample Program (NSP) of the National Trauma Databank was queried to identify all patients who sustained pelvic and acetabular fractures. The NSP contained 41,297 cases of pelvic trauma. In-hospital mortality was documented in 3,055 (7%) and one or more complications occurred in 6,932 (17%). Cardiac events transpired in 2% of patients, venous thromboembolic disease (VTED) in 4%, and infections in 3%. [12]

Increasing age, shock, time to procedure, and Glasgow Coma Scale (GCS) rating were predictive of mortality. Cardiac events were found to be influenced by obesity, diabetes, Injury Severity Score (ISS), GCS score, age, and trauma mechanism. VTED was impacted by obesity, history of respiratory disease, male sex, GCS score, and medical comorbidities. Injuries caused by mechanisms other than blunt trauma, shock, age, GCS score, and medical comorbidities were associated with infection.

Acetabular fractures are often associated with knee injuries. In one study, of 1273 patients with acetabular fractures, 193 (15%) were found to have ipsilateral knee symptoms within a period of 1 year from the date of injury, including 56 fractures (29%), 49 ligamentous lesions (25%), and 88 miscellaneous (46%) injuries, including bone bruises, wounds, and swelling. In the 193 cases of knee injury, other injuries included 85 patients with ipsilateral hip dislocation (45%), 59 pelvic injuries (31%), 61 extremity injuries (32%), 38 head injuries (20%), 37 chest injuries (20%), 23 abdominal and genitourinary injuries (12%), and 7 injuries of the spine (4%). [13]


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