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Age < 40-years-old
4%
104/2724
Requiring skeletal traction to maintain reduction
6%
161/2724
>3 failed reduction attempts upon presentation
11%
287/2724
Delay in internal fixation of the acetabulum fracture > 5 days
10%
278/2724
Delay in closed reduction >12 hours
68%
1852/2724
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Delay in reduction >12 hours is associated with poor outcomes in the setting of native hip dislocations. Posterior wall fractures are the most common type of acetabular fractures and are commonly associated with hip dislocations. A prompt closed reduction should be performed upon diagnosis of native hip dislocation. Following successful reduction, the patient can be placed in a knee immobilizer or abduction pillow to aid in maintaining reduction. Occasionally, for unstable injuries, skeletal traction may be needed to maintain reduction. A CT scan should be obtained following reduction to evaluate for femoral head impaction, intraarticular fragments and to further confirm reduction. Several factors including delay in reduction >12 hours, age >40-years old, intraarticular comminution, and osteonecrosis have been associated with poorer clinical outcomes. Moed et al. reviewed outcomes following acetabular fracture-dislocations. They found a delay in reduction >12 hours to be associated with poor clinical outcomes post-injury. They conclude that prompt reduction should be performed upon diagnosis of hip dislocations. Mears et al. review the indicators of outcome following displaced acetabular fractures. They report that anatomic reduction was achieved in 76% of patients treated within the first 2 days following the injury. This number fell to 68% and 54% for those treated 3-10 days and 11-21 days out from injury, respectively. They conclude that delay of surgery > 11 days is associated with worsening rates of anatomic reduction and outcomes. Figure A is an AP radiograph demonstrating a right hip fracture-dislocation. Incorrect Answers: Answer 1: Age >40-years-old is associated with poorer outcomes (post-traumatic osteoarthritis) following acetabular fractures. Answer 2: Failed reduction attempts have not been linked to poor outcomes postoperatively. Answer 3: While requiring skeletal traction may be associated with more severe injuries, it has not directly been linked to worse outcomes. Answer 4: Delay in internal fixation of the acetabulum > 11 days is associated with a decreased rate of anatomic reduction.
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