Does early fixation of posterior wall acetabular fractures lead to increased blood loss?

OBJECTIVE

Controversy exists regarding the ideal timing of acetabular fracture surgery. Surgery within the first 24 hours might put patients at risk for increased blood loss; however, early treatment might facilitate fracture reduction and patient mobilization. The purpose of this study was to determine whether early surgery for posterior wall acetabular fractures results in higher intraoperative blood loss.

DESIGN

Retrospective review.

SETTING

Level I academic trauma center.

METHODS

A 1-year retrospective review of 49 consecutive posterior wall acetabular fractures from a single Level I trauma center. Outcome variables were analyzed with t tests, Pearson correlation coefficient, and multiple linear regression analysis.

INTERVENTION

Surgery for posterior wall acetabular fractures.

MAIN OUTCOME MEASURES

Estimated blood loss (EBL), preoperative and postoperative hematocrit levels, and intraoperative and postoperative blood product requirements as a function of the timing of surgery.

RESULTS

No difference in EBL was shown between the fractures fixed within 24 hours of injury (mean = 644 mL) and those fixed later (573 mL, P = 0.50). No difference was observed when analyzing timing of surgery as a continuous variable (P = 0.45) or other outcome variables. A post hoc power analysis demonstrated that our sample could detect a difference in EBL of 166 mL.

CONCLUSIONS

Our study suggests that posterior wall fractures might be a subset of acetabular fractures that can be treated immediately without increased risk of excessive blood loss. It should be emphasized that our findings should not be applied to other more complex types of fractures of the acetabulum.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.