Patient and fracture characteristics associated with six-month patient-reported outcomes following acetabular fracture fixation.

Abstract

Patient-reported outcomes (PROs) after acetabular fracture fixation vary widely, and the influence of demographic, injury, and fracture characteristics on early recovery remains incompletely defined. This study evaluated factors associated with six-month PROs following operative fixation of acetabular fractures. The authors hypothesized that greater injury burden, as measured by Injury Severity Score (ISS), and more complex fracture patterns would be associated with worse six-month PROs. Adult patients who underwent operative fixation of acetabular fractures (AO/OTA 62) at a single Level I trauma center (June 2022-October 2024) were retrospectively identified. Patients completing six-month Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function [PF], Pain Interference [PI], Global Physical Health [GPH], Global Mental Health [GMH], anxiety, depression), Brief Resilience Scale (BRS), and percent of normal function surveys were included. PROs were compared by sex, race, fracture pattern (elementary vs associated), and polytrauma status (ISS > 16). Unadjusted and adjusted analyses were performed controlling for age, sex, race, Letournel classification, concomitant infection, and other orthopaedic injuries. A total of 109 patients completed six-month surveys (mean age 50.6 years; 64.2% male). On unadjusted analysis, female patients reported higher PI (62.5 vs 58.8, p = 0.032) and higher depression (58.1 vs 51.7, p = 0.009). After adjustment, female sex remained associated with higher PI (p = 0.012), worse GPH (p = 0.029), higher depression (p = 0.032), and lower percent of normal (p = 0.037). Nonwhite patients demonstrated worse unadjusted GPH (39.0 vs 43.0, p = 0.028), worse GMH (41.5 vs 46.6, p = 0.018), higher anxiety (58.9 vs 51.4, p = 0.005), and lower BRS (3.2 vs 3.7, p = 0.032). After adjustment, nonwhite race remained associated with worse GPH (p = 0.014), worse GMH (p = 0.029), higher anxiety (p = 0.050), higher PI (p = 0.039), and lower BRS (p = 0.050). No significant differences were observed by polytrauma status or fracture pattern. At six months following acetabular fracture fixation, female sex and nonwhite race were associated with worse PROs across multiple domains, while fracture pattern and polytrauma status were not significant after adjustment.