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This patient has sustained an anterior column acetabular fracture. Delay of fixation for more than 3 weeks is associated with difficulty in achieving adequate reduction and poor outcomes. Historically earlier treatment of acetabular fractures has been shown to improve clinical and functional outcomes. Delays of more than 3 weeks have been associated with difficulty obtaining an anatomic reduction and decreased overall patient outcomes. An increased delay has not been shown to increase the chances of neurological injury, infection, or heterotopic ossification. Plaisier et al. performed a study to evaluate the effect of the timing of fixation for acetabular and pelvic ring fractures on patient outcome. They found that early fixation of acetabular fractures was associated with a decreased total length of stay. Functional outcome was improved in early fixation of acetabular fractures with a greater proportion of patients being discharged home rather than to rehabilitation or skilled care. They conclude that patients with early repair of acetabular fractures had significantly less organ dysfunction and exhibited improved functional outcome. Madhu et al. performed a retrospective case review to determine if the time to surgery was predictive of radiological and functional outcomes of acetabular fractures. For elementary fractures, an increase in the time to surgery of one day reduced the odds of an excellent/good functional result by 15% and of an anatomical reduction by 18%. For associated fractures, the odds of obtaining an excellent/good result were reduced by 19% and an anatomical reduction by 18% per day. They conclude that the time to surgery is a significant predictor of radiological and functional outcome for both elementary and associated displaced fractures of the acetabulum. Figure A is an AP pelvis demonstrating a displaced fracture of anterior column. Incorrect Answers: Answers 1, 2, 3, & 4: Delay of fixation for more than 3 weeks is associated with difficulty in achieving adequate reduction and poor outcomes.
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