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Open Access Research article

Radiographic analysis of the restoration of hip joint center following open reduction and internal fixation of acetabular fractures: a retrospective cohort study

Hong-fei Shi, Jin Xiong, Yi-xin Chen*, Jun-fei Wang and Yin-he Wang

Author Affiliations

Department of Orthopaedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China

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BMC Musculoskeletal Disorders 2014, 15:277  doi:10.1186/1471-2474-15-277

Published: 13 August 2014

Abstract

Background

Unfavorable reduction is considered one of the key factors leading to joint degeneration and compromised clinical outcome in acetabular fracture patients. Besides the columns, walls, and superior dome, the postoperative position of hip joint center (HJC), which is reported to affect hip biomechanics, should be considered during the assessment of quality of reduction. We aimed to evaluate the radiographic restoration of HJC in acetabular fractures treated with open reduction and internal fixation.

Methods

Patients with a displaced acetabular fracture that received open reduction and internal fixation in the authors’ institution during the past five years were identified from the trauma database. The horizontal and vertical shifts of HJC were measured in the standard anteroposterior view radiographs taken postoperatively. The radiographic quality of fracture reduction was graded according to Matta’s criteria. The relationships between the shift of HJC and the other variables were evaluated.

Results

Totally 127 patients with 56 elementary and 71 associated-type acetabular fractures were included, wherein the majority showed a medial (89.0%) and proximal (93.7%) shift of HJC postoperatively. An average of 2.8 mm horizontal and 2.2 mm vertical shift of HJC were observed, which correlated significantly with the quality of fracture reduction (P < 0.001 for both). The horizontal shift of HJC correlated with the fracture type (P = 0.022).

Conclusions

The restoration of HJC correlates with the quality of reduction in acetabular fractures following open reduction and internal fixation. Further studies are required to address the effects of HJC shift on the biomechanical changes and clinical outcomes of hip joint, especially in poorly reduced acetabular fractures.

Keywords:
Acetabular fracture; Open reduction and internal fixation; Hip joint center; Radiography