Time to surgery may be critical factor in outcomes for acetabular fracture treatment

Odds for anatomic reduction declined with increased delay in patients sent to referral centers for care.

PHOENIX - Delaying surgery for acetabular fractures can significantly decrease the chances for achieving acceptable anatomic reduction and function, according to British researchers.

Researchers from the John Radcliffe Hospital in Oxford, England, analyzed data on 254 consecutive patients with acetabular fractures. Of these, 75% were transferred to a referral center for surgical treatment.

Co-investigator Keith Willett, FRCS, and his colleagues followed the referred group for a minimum of 2 years. Using Letournel’s classification, they categorized the fractures as elementary/simple or associated/complex. The investigators also performed postoperative radiological and functional assessments.

They defined fractures with less than 2 mm of separation as “anatomically reduced,” while those with 2 mm or less were categorized as “adequately reduced.” “Poorly reduced” fractures measured greater than 2 mm.

Investigators discovered that the odds of obtaining an anatomic reduction and good or excellent function dropped between 15% to 19% each day that surgery was delayed.

Postponing surgery for an elementary fracture by one day significantly decreased the chances for good or excellent function (P=.001) and anatomic reduction (P=.0001). Patients with associated fractures waiting the same time also had significantly lower odds for the same level of function and quality of reduction (both P=.0001), the researchers wrote in their abstract.

They also found that a statistically significant decline in the odds of obtaining an anatomic reduction becomes statistically significant at 16 to 20 days postinjury (P=.004) for a simple fracture and 6 to 10 days for an associated fracture (P=.008). They also discovered a higher incidence of poor functional outcomes for simple fractures after 14 days, while function decreased for complex fractures after 9 days.

“We therefore conclude that regional and national trauma referral systems must be capable of achieving these time-critical targets,” said Willett, an orthopaedic trauma surgeon at the hospital, in his presentation at the Orthopaedic Trauma Association annual meeting. “Then, we should think about prioritizing the complex patients and simple fracture patterns.

“This study has shown that in the United Kingdom, we still have a significant problem with patients being referred regionally, and we must address that,” he added.

For more information:
Kotnis R, Madhu R, Al-Mousawi A, et al. Outcomes of acetabular fracture reconstruction surgery: The time-critical effect of delay. #42. Presented at the Orthopaedic Trauma Association 22nd Annual Meeting. Oct. 4-7, 2006. Phoenix.
Prof. Willett has indicated that he has no conflict of interest to report in this investigation.