0
Scientific Articles   |    
Outcomes of Posterior Wall Fractures of the Acetabulum
Berton R. Moed, MD1; Jessica C. McMichael, MD1
1 Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 7th Floor, Desloge Towers, St. Louis, MO 63110. E-mail address for B.R. Moed: moedbr@aol.com
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jun 01;89(6):1170-1176. doi: 10.2106/JBJS.F.00473
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

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.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Hip
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    11/15/2013
    Louisiana - Ochsner Health System
    05/03/2012
    California - UCLA/OH Department of Orthopaedic Surgery
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center