BACKGROUND: The Musculoskeletal Function Assessment (MFA) is a
validated, reliable, self-administered questionnaire that is useful for
determining functional status. The Merle d'Aubigné score is a clinical
measure of hip function. The purpose of the present study was to evaluate the
outcome information provided by these two instruments after operative
treatment of elementary posterior wall fractures of the acetabulum.
METHODS: Forty-six patients who had been followed for a minimum of
two years after operative treatment of an elementary posterior wall fracture
of the acetabulum were included in the study. Functional outcomes were
assessed with use of the ten individual indices and total score of the MFA,
and clinical outcomes were evaluated with use of the Merle d'Aubigné
score. The MFA scores were compared with previously reported normative values
and with previously reported values for similar patients with hip injuries.
The duration of follow-up ranged from two to fourteen years (mean, five
years).
RESULTS: The mean Merle d'Aubigné score was 17 (standard
deviation, 1; range, 14 to 18), indicating overall good-to-excellent clinical
results. However, the mean total MFA score was 23.17, which was significantly
worse than the normative mean of 9.26 (p < 0.001). All MFA indices except
hand/fine motor were similarly significantly worse than expected norms. The
mean MFA total score was statistically similar to that reported by others for
patients with hip injuries. The emotional category of the MFA score was found
to be an important determinant of the total score. The Spearman rho
correlation coefficient between the Merle d'Aubigné score and the MFA
score was 0.62 (p < 0.001). However, the Merle d'Aubigné score data
were asymmetric, demonstrating a ceiling effect (crowding of the scores at the
upper end of the scale, limiting the ability of the score to demonstrate
differences between patients with supposedly better clinical outcomes).
CONCLUSIONS: The total MFA scores for patients with a posterior wall
fracture of the acetabulum were significantly worse than normative reference
values. Thus, complete recovery after a posterior wall fracture of the
acetabulum is uncommon, with residual functional deficits involving
wide-ranging aspects of everyday living that do not necessarily have an
obvious direct connection to hip function. Although the modified Merle
d'Aubigné score may be useful for evaluating isolated hip function in
patients who have been treated for an acetabular fracture, its shortcomings
limit its usefulness as a method for evaluating functional outcome in these
patients. Research efforts should be directed toward the identification of the
psychosocial and other underlying determinants of functional outcome and
potential related treatment interventions.
ORIGINAL ABSTRACT CITATION: "Outcomes of Posterior Wall Fractures of
the Acetabulum"
(2007;89:1170-6).