Minimally invasive screws fixation of displaced fractures of the acetabulum: a 7 years single center experience.

Abstract

PURPOSE: Evaluate outcomes of minimally invasive screw fixation for displaced acetabular fractures, focusing on intraoperative parameters, postoperative radiologic and clinical results, and complications. METHODS: From June 2016 to April 2023, 16 patients underwent closed or limited open reduction with percutaneous fixation. Variables were sex, age, trauma mechanism, Judet–Letournel classification, and initial displacement on radiographs and CT. Operative data included procedure duration, fluoroscopy time and dose, and intraoperative blood loss. Reduction quality was graded by Matta on Judet views and/or postoperative CT. Perioperative complications and Harris Hip Scores (HHS) at 6 and 12 months were recorded. RESULTS: Fourteen men and two women (mean age 58); traffic accidents caused 69% of injuries. Fractures were elementary in 19% and associated in 81%; 50% showed marginal impaction. Mean operative time was 159 min; fluoroscopy time 2.75 min; mean blood loss 372 mL. Initial displacement averaged 6.3 mm on radiographs and 7 mm on CT, improving postoperatively to 2 mm and 3 mm (p < 0.001). On radiographs, reductions were anatomical in 8, satisfactory in 5, and poor in 3; on CT, 36% were anatomical, 45% satisfactory, and 18% poor. HHS averaged 95 at 6 months and 97 at 12 months. Complications included one intra-articular drill-bit breakage requiring open removal, two prolonged hospitalizations, five transient lateral femoral cutaneous nerve palsies, and two secondary displacements. No infections, emboli, major vascular injuries, avascular necrosis, or post-traumatic arthritis occurred; all fractures healed. CONCLUSION: Percutaneous fixation by experienced surgeons is a feasible, low-morbidity alternative to open reduction for selected fractures.