Vol. 11, Issue 3 (2025)

Background: Acetabular fractures that involve both the anterior and posterior columns present a significant challenge due to their complex nature. Historically, surgical management often focused on stabilizing one column, with the expectation that the opposing column would reduce indirectly. However, this approach can compromise the accuracy of fracture reduction and overall joint congruency. The present study aims to assess the functional outcomes in patients with complex acetabular fractures managed through direct fixation of both columns, offering a more comprehensive approach to restore anatomical alignment and joint stability.
Materials and Methods: A prospective interventional study was conducted from 2023 to 2025 at a Level 1 trauma center on 30 patients (mean age 40.8 years, range 18-59 years) with complex both-column acetabular fractures, primarily due to high-energy trauma. Preoperative evaluation included AP and Judet radiographs with 3D CT reconstructions, and fractures were classified using the Judet-Letournel system. Surgical management utilized combined anterior and posterior approaches (Modified Stoppa, Ilioinguinal, Iliofemoral with Kocher Langenbeck) based on fracture morphology, with internal fixation using reconstruction plates with or without additional screws. Intraoperative data including operative time, blood loss, and transfusion requirements were recorded. Early mobilization with heterotopic ossification prophylaxis was provided postoperatively. Radiological assessments were performed using serial AP and Judet views, while functional outcomes were evaluated using the Visual Analog Scale (VAS) for pain, Modified Merle d’Aubigné Score, and Harris Hip Score at 3 and 6 months.

Observations and Results: Of the 30 patients, 70% were male and 30% female, with a mean hospital stay of 19 days. The mean operative time was 6.1 hours, with an average intraoperative blood loss of 802 mL and transfusion requirement of 1.5 units. Fracture types included anterior column with posterior hemitransverse, transverse with posterior wall, T-type, and both-column patterns, with associated hip dislocations seen in 36.7% of cases. Fixation was performed using plating alone in 56.7% and plating with additional screws in 43.3% of cases. Radiographs demonstrated satisfactory alignment and union in all patients. No complications occurred in 80% of cases, while minor complications were managed conservatively. The mean VAS score at 3 months was 0.17, while at 6 months, the Modified Merle d’Aubigné Score averaged 17/18, and the Harris Hip Score averaged 98.1/100, indicating excellent functional recovery. 
Conclusion: Fixation of both anterior and posterior columns in complex acetabular fractures enables accurate reduction, stable fixation, and early rehabilitation, resulting in excellent short-term functional and radiological outcomes with a low complication rate. Careful fracture assessment, appropriate surgical approach selection, and meticulous surgical technique are essential for achieving optimal patient outcomes.