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Achieving Anatomic Acetabular Fracture Reduction—When is the Best Time to Operate?

Dailey, Steven K. MD; Phillips, Caleb T. PhD; Radley, Joseph M. MD; Archdeacon, Michael T. MD, MSE

doi: 10.1097/BOT.0000000000000576
Original Article

Objectives: We hypothesize that earlier operative intervention for acetabular fractures improves the probability of achieving an anatomic reduction.

Design: Retrospective review.

Setting: Academic level I trauma center.

Patients/Participants: Six hundred fifty acetabular fractures treated through open reduction and internal fixation (ORIF) between September 2001 and February 2014.

Intervention: Acetabular fracture ORIF.

Main Outcome Measurements: Reduction quality was assessed through postoperative radiographs. Displacement of ≤1 mm was considered an anatomic reduction, 2–3 mm imperfect, and >3 mm poor.

Results: Anatomic reductions were observed in 85% (n = 553) of cases, imperfect reductions in 11% (n = 74) of cases, and poor reductions in 4% (n = 23) of cases. Patients with anatomic reductions had significantly shorter times from injury to ORIF [odds ratio (OR) interval] (median, 3 d) when compared with either imperfect (median, 4.5 days, P = 0.02) or poor reductions (median, 7 days, P < 0.001) reductions. The OR interval of imperfect reductions was also significantly shorter than that of poor reductions (P = 0.02). Logistic regression analysis demonstrated that OR interval had an effect of −0.12, meaning that the log odds of anatomic reduction decreases by 0.12 with each day from injury to ORIF.

Conclusion: The interval from injury to operative fixation of acetabular fractures affects reduction quality. Earlier intervention improves the probability of achieving an anatomic reduction; therefore, ORIF should be performed as early as possible, provided the patient is optimized for surgery.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH;

Department of Computer Science and Engineering, University of Colorado, Boulder, CO; and

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA.

Reprints: Steven K. Dailey, MD, University of Cincinnati, Department of Orthopaedics and Sports Medicine, PO BOX 670212, Cincinnati, OH 4267–0212 (e-mail:

Presented as a podium presentation at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Las Vegas, NV, March 24–28, 2015, at the Annual Meeting of the Orthopaedic Trauma Association, San Diego, CA, October 7–10, 2015 and at the Ohio Orthopaedic Society Annual Meeting, Dublin, OH, May 14–15, 2015. Also presented as a poster at the Mid-America Orthopaedic Association, Hilton Head, SC, April 22–26, 2015.

Dr M. T. Archdeacon is a paid consultant for Stryker, lectures for Stryker, AO North America, and Smith & Nephew, and receives royalties from SLACK incorporated. The remaining authors report no conflict of interest.

Approval from the University of Cincinnati IRB was obtained before the conduction of this study.

Accepted March 03, 2016

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