Stein Øvre

Background In acetabular fracture treatment, 3 disease-specific outcome scores are mainly used: the original and modified Merle d'Aubigné-Postel Score, and the Harris Hip Score. Methods The original and modified Merle d'Aubigné-Postel Score and the Harris Hip Score were recorded in 1,153 follow-ups of 450 patients. 492 follow-ups were excluded because factors other than the acetabular fracture were found to affect the outcome scores. This gave 661 patient records for the study. Results The Spearman correlations were between 0.81 and 0.89. The quartile analyses showed Kappa agreement between 0.45 and 0.55. About 40% of the observations were classified into another quartile when switching from one outcome score to another. The 25th and 50th percentiles comprised 85% and 95% of the total numeric scores, respectively, while the 75th percentiles showed ceiling value (100% of the maximum) in all 3 scores. Interpretation Despite the excellent overall correlation between the outcome scores, the Kappa agreements were only moderate. The scores were all skewed in distribution with considerable ceiling effects that could limit their clinical use. The scores did not capture any differences in 25% of the observations at the upper end of the scales. ▪

Background Classification of fractures is crucial in decision making and planning of acetabular surgery. Transverse fractures with secondary vertical fracture lines—which constitute either a large posterio-superior fragment (floating dome) or an inverse T with the posterior ileum attached to the axial skeleton—have not been described in detail in the literature. Methods All acetabular fractures at Ullevål University Hospital have been recorded prospectively since 1993 and classified according to Judet/Letournel. Results In 10/449 fractures (2%) there was a transverse fracture line through the acetabulum, with an additional vertical fracture line ascending either to the iliac crest or the SI-joint. In 6 of these fractures the vertical line started within the acetabulum, and the posterior part of the ileum with part of the articular surface was attached to the axial skeleton. In 4 fractures the vertical fracture line started posterior to the joint, constituting a very large posterio-superior fragment without any articular surface (a floating dome). Interpretation Open reduction and internal fixation of inverse T-fractures and transverse fractures with a floating dome require different surgical approaches. The latter can be treated through a single approach alone, while the inverse T-fracture may require extensile or combined approaches for adequate reduction and fixation. ▪