Abstract / Summary
Acetabular both-column fractures (BCFs) are surgically demanding lesions associated with a high risk of postoperative complications. While standard open reduction and internal fixation (ORIF) yields satisfactory outcomes for acute BCFs, clinical evidence for cases treated more than three weeks after injury remains limited. This study aimed to compare perioperative and short-term functional outcomes of ORIF between acute and chronic acetabular BCFs, and evaluate the feasibility of salvage reconstructive surgery for delayed cases. A total of 74 patients with 75 injured hips who underwent ORIF for acetabular BCFs between 2019 and 2022 were retrospectively included. Participants were stratified into two cohorts by surgical timing. The acute cohort received surgery within 3 weeks post-injury, and the chronic cohort underwent operation at 21–30 days post-injury. Baseline demographic and surgical data were collected. Postoperative computed tomography (CT) was used to measure residual articular gap and step-off. Hip function was evaluated using the Harris Hip Score (HHS) and modified Merle d’Aubigné-Postel score (mMDPS), assessed independently by two blinded observers. Univariable and multivariable linear regression were performed to identify factors associated with operative duration and intraoperative blood loss. The acute group comprised 64 injured hips and the chronic group 11 hips. Baseline demographic characteristics were comparable between groups at the patient level. The chronic group had a significantly longer operative duration, greater intraoperative blood loss, higher number of transfused blood units, and a higher incidence of combined surgical approaches and multiple associated injuries. Univariable and multivariable linear regression verified that both chronic fracture status and combined surgical approach were independently associated with prolonged operative time and increased intraoperative blood loss. Substantial collinearity between the two factors limits definitive interpretation of their relative magnitude. Although the acute group achieved a higher rate of anatomical reduction on postoperative CT, no statistically significant intergroup differences were observed in mean residual articular gap or step-off. No statistically significant disparities in HHS or mMDPS were detected between groups at 1-year or final follow-up. The overall postoperative complication rate was 27.03% at the patient level. Univariable logistic regression showed that fracture stage, age, associated injuries and surgical approach were not significantly associated with dichotomized short-term postoperative functional scores. Stable odds ratios could not be computed for several variables due to complete separation in the small chronic subgroup. Clinically acceptable fracture reduction and promising short-term functional recovery may be achievable with salvage reconstructive surgery for appropriately selected patients receiving operative intervention at 21–30 days post-injury, even when complete anatomical reduction is not attained. Delayed ORIF carries substantial perioperative burden and elevated complication risk, and should be undertaken only in carefully selected patients treated at specialized trauma centres by experienced surgical teams. Fracture chronicity and combined surgical approach are both associated with longer operative duration and greater intraoperative blood loss. Large multicentre prospective studies with extended follow-up are warranted to validate these findings and evaluate long-term hip survival.