Analysis of the risks of complications after metal osteosynthesis for acetabular fractures

Background. Acetabular fractures were and still are a complex, not fully solved problem. Despite the entire modern arsenal of therapeutic measures, these injuries lead to disability in 73–88 % of cases. Objective: to evaluate the time of the hip joint “survival” and to analyze the risks of complications after metal osteosynthesis for acetabular fractures. Materials and methods. A retrospective analysis was performed of the development of complications after metal osteosynthesis in 65 patients with acetabular fractures. The analysis was conducted using the Kaplan-Meier survival function. Comparison of the results of arthroplasty was performed by the xi-square (Cramr’s V). Statistical calculations were done in IBM SPSS Statistics 26.0. Results. There were 3 main stages of complications development. Stage I (n = 46) — rapid development of complications that required hip arthroplasty in the first 2 years after injury. Stage II (n = 12) — complications appeared in the period from 24 months to 10–12 years, which led to joint replacement during this time. Stage III — late manifestations of joint disease with arthroplasty later than in 10 years. Among 54 patients who suffered acetabular fracture, 52 % (28 patients) required hip arthroplasty in the first 2 years after the injury, mainly due to osteosynthesis complications. According to the results of total hip replacement, only 9 (32.1 %) of them had a good treatment outcome, and 6 (21.4 %) reported a poor outcome. Arthroplasty within 10 years after the injury was performed in 18 (33.3 %) patients with early development of hip dege­nerative diseases such as coxarthrosis and/or aseptic necrosis. Only in 8 (14.8 %) patients who underwent arthroplasty in 10 years or later, the results of fracture treatment without replacement can be considered good, and joint arthroplasty can be considered necessary due to age-related changes. Conclusions. The analysis determined that most complications after treatment of acetabular fractures with osteosynthesis occurred in the first 2 years and patients required arthroplasty due to poor joint condition and recurrent dislocation. Only a small proportion of patients, mostly of young age, underwent this treatment with a positive outcome and developed degenerative complications in the long term. The low overall outcome of fracture treatment with osteosynthesis calls for a reassessment of treatment approaches in such injuries, which may include combined hip arthroplasty immediately after injury.