Vol. 11, Issue 4 (2025)

Introduction: The treatment of displaced acetabular fractures remains controversial between supporters of osteosynthesis and those of orthopedic treatment. Whichever option is chosen, the therapeutic approach must be adequate to avoid harmful functional complications. The aim of this study was to compare the preliminary results of surgically or orthopedically treated acetabular fractures.
Patients and Methods: The study was a prospective observational comparative study, following STROBE guidelines. It was conducted from October 2019 to February 2024 and included 64 patients, 32 of whom underwent osteosynthesis and 32 orthopaedic treatment. All patients treated for displaced acetabular fractures were included. Anatomical results were assessed using the Duquennoy and Sénégas and Matta criteria. Functional results were assessed using the Postel Merle d'Aubigné score.
Results: The gain in vertical congruence (TT) was 62.4% after orthopaedic treatment and 93.8% after osteosynthesis. The gain in horizontal congruence (TC) was 56.2% after orthopaedic treatment and 81.3% after osteosynthesis. After multivariate modelling taking into account the type of fracture as a confounding factor, anatomical outcomes after osteosynthesis were significantly better only in elementary fractures (P=0.039 vertical congruence; P=0.012 horizontal congruence). Similarly, after a 24-month follow-up, functional prognosis after osteosynthesis was significantly better only in elemental cotyle fractures (P=0.013). Two late complications were found. They were Arlet and Ficat's stage 2 avascular osteonecrosis of the femoral head in one orthopedically treated patient (follow-up=16 months) and another surgically treated patient (follow-up=9 months).
Conclusion: Osteosynthesis provided better anatomical and functional outcomes than orthopaedic treatment at 24 months follow-up. These results were significantly better in elementary Letournel and Judet fractures, and similar in complex fractures. Conservative treatment nevertheless gave average and good outcomes when post-traction congruence was restored and maintained. It therefore has a definite place, provided the correct indication is respected, particularly residual displacements of less than 3 mm (anatomical and imperfect reductions according to Matta criteria).