Internal fixation of acetabular fractures in an older population using the lateral-rectus approach: short-term outcomes of a retrospective study

PurposeThis study aims to examine the clinical efficacy and surgical techniques of the lateral-rectus approach for treatment of acetabular factures in elderly patients.MethodsAfter appropriate exclusion, 65 elderly patients with an acetabular fracture who was treated through the lateral-rectus approach from January 2011 and October 2016 were selected retrospectively. By analyzing the medical records retrospectively, the patients' characteristics, fracture type, mechanism of injury, comorbid conditions, ASA class, operative time, intra-operative blood loss, and post-operative complications were assessed. Clinical examination radiographs have been taken, align with the Matta evaluation system. Functional outcomes were evaluated using surveys including SF-36, Harris hip score, and modified Merle D'Aubigne-Postel.ResultsAll 65 patients had undergone the single lateral-rectus approach successfully. Surgery duration was 101.23min on average (45-210), and intra-operative bleeding was 798.46ml on average (250-1800). According to the Matta radiological evaluation, the quality of reduction evaluated 1week after surgery was rated as anatomical in 41 (63.1%) cases, imperfect in 12 (18.5%) cases, and poor in 12 (18.5%) cases. The modified Merle D'Aubigne-Postel score performed 18months after surgery was categorized as excellent in 40 (61.5%) cases, good in 10 (15.4%) cases, and fair in 15 (23.1%) cases. The mean Harris Hip score was similar as present researches, being 87.18. The mean SF-36 score was 69.12 which was considered as normal for the group age 60 and older. Several complications were found, including screw loosening in 10 cases, fat liquefaction of incision in 2 cases, deep vein thrombosis in 2 cases, and temporary weakness of hip adductors in 5 cases. None of the patients had heterotopic ossification.ConclusionsThe lateral-rectus approach is a valuable alternative to the ilioinguinal and modified Stoppa approach, being the treatment of acetabular fractures in elderly patients.