Functional outcome and quality of life after surgical management of displaced acetabular fractures in Tanzania

Abstract

Objective: To determine the functional outcome and quality of life of acetabular  fracture patients treated operatively with open reduction and internal fixation.
Design: Retrospective case series.
Subjects: Patients aged 18 to 65 years old undergoing operative treatment for  acetabular fractures from October 2010 to September 2014.
Study area: Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
Outcome measures: Modified Merle d’Aubigne scale and “Squat and Smile” test for functional outcome. EQ-5D for quality of life.
Results: Thirty four patients were followed-up for an average of 34 months  postoperatively. Patients most commonly had elemental posterior wall fractures (59%) and were most frequently (93.8%) treated by the Kocher-Langenbeck  approach. The majority of patients self-reported good to excellent scores on the Merle d’ Aubigne, “no problems” on the EQ-5D, and were able to perform a full squat. Patients who were operated on >6 weeks post-injury reported lower Merle d’Aubigne (15.0 vs. 16.4, p=0.077) and EQ-5D (0.72 vs. 0.92, p=0.015) scores compared to patients operated on <6 weeks since injury. Two patients reported infection and five reported avascular necrosis, four of which required hip replacements.
Conclusions: Operative treatment of acetabular fractures, particularly posterior  approaches for elemental posterior wall approaches, can lead to good outcomes with acceptable complication rates at a busy trauma center in East Africa. Operating on patients less than six weeks after injury leads to better functional outcome. Future investigation into anterior and extensile approaches performed in a LMIC hospital is warranted.