ORIGINALARTICLE

OUTCOMES OF SURGICAL TREATMENT IN ACETABULAR FRACTURES

Muhammad Aamir¹, Israr Ahmad², Waseem Khan¹, Shah Hassan¹

How to cite this article

ABSTRACT

OBJECTIVES

This study aimed to determine the outcomes of surgical treatment in

Aamir M, Ahmad I, Khan W, Hassan

S. Outcomes of Surgical Treatment in

Acetabular Fractures. J Gandhara Med

Dent Sci.2026;13(2):77-80

acetabular fractures at Hayatabad Medical Complex, Peshawar.

METHODOLOGY

This prospective observational study was conducted at the Department of

Orthopaedics and Spine at Hayatabad Medical Complex, Peshawar,

Pakistan, from 1^stJanuary 2025 to 15^thOctober 2025. The hospital's ethics

committee approved the study. All adult patients of either sex aged 18 to 75

years, with an acetabular fracture with> 2 mm displacement of the articular

surface, <45º of Matta's roof arc angle, or a fracture with instability aecting

more than 20% of the posterior wall, were included in the study. The mean

Harris hip score was compared between Group A and Group B using a

paired-samples t-test, and structural outcomes were compared between the

groups using Matta's criteria.

https://doi.org/10.37762/jgmds.13-2.828

Date of Submission: 16-10-2025

Date Revised:

15-12-2025

16-12-2025

Date Acceptance:

²Professor, Department of Orthopaedics,

Hayatabad Medical Complex, Peshawar

RESULTS

Of the 12 patients included in our study, 10 (83%) were men, and 2 (17%)

were women. 9(75%) patients had age <45 years & 3(25%) patients had

age>45 years to 75years. Both structural and functional outcomes were

compared using a paired-samples t-test, and the results were statistically

signicant (p-value < 0.05), indicating the eectiveness of acetabular

fracture xation.

Correspondence

¹Muhammad Aamir, Trainee Medical

Ofcer, Department of Orthopaedics,

Hayatabad Medical Complex, Peshawar

CONCLUSION

+92-313-9680452

aamirgandapur998@gmail.com

A favourable structural and functional outcome can be obtained with surgical

therapy for displaced acetabular fractures. Properly diagnose the fracture

pattern, and plan and perform the appropriate surgical approach with

careful procedural planning.

KEYWORDS: Acetabular Fracture, Harris Hip Score, Matta’s Criteria

INTRODUCTION

with posterior hemi transverse (14.9-24%).⁷A fracture

that is displaced, i.e., >2mm displacement (articular

step), is an indication for surgery. Further indications

include intact roof-arc angle < 30º and Intra-Articular

Acetabular fractures are complex injuries, following

Road trac accidents, falls from height, and pediatric

accidents.¹The annual incidence of acetabular fractures

is 3 per 100,000 population/year.²Currently, 12-14% of fragmentation or impaction. The goal of surgery is

stable internal xation and restoration of anatomical

articular congruity by precise reconstruction of the

acetabular dome with acetabular screws or plates, to

achieve the best functional outcome in terms of painless

range of motion.^8,9The complications that accompany

acetabular fractures occur in the elderly population, i.e.,

age > 65 years.³In young patients, acetabular fractures

are caused by strong axial force acting through the

femoral shaft or directly exerted force through the

greater trochanter, while in old age, bones are

osteoporotic, and low-energy trauma can cause acetabular fractures and surgery are numerous, e.g.,

acetabular fractures.⁴The poor outcomes of acetabular

Sciatic nerve injury, infection, DVT, femoral head

osteonecrosis, and secondary osteoarthritis. Some of the

above complications demand later revision surgery in

the form of Total hip replacement. So, for acetabular

fractures with conservative treatment in the 1950s led

Letournel and Judet to develop a classication for

acetabular fractures.⁵There are 5 elemental types, i.e.,

Posterior wall, Posterior column, Anterior wall, surgeries, continuous education for surgeons and

Anterior column, and Transverse. The associated surgical

experience

are

mandatory

for

better

patterns are Posterior column with posterior wall, outcomes.^10,11

Faizi et al.¹²from Kuala Lumpur,

Transverse posterior wall, T-style, Anterior column- Malaysia, in their study, found that after ORIF of

posterior hemi-transverse, and Both columns fracture.⁶acetabular fractures, 66.7% (20/30) of patients showed

Among these types, both column fractures are most excellent/good results, i.e., Harris Hip score ≥80.

common (26.4-28%), followed by the anterior column Postoperative complications were degenerative changes

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J Gandhara Med Dent Sci

Outcome of Surgical Treatment in Acetabular

in the hip joint (43.3%), Avascular necrosis (16.7%), posterior fractures (i.e., Posterior wall, transverse, or

iatrogenic sciatic nerve injury (10%), deep infection Posterior column fractures), the Kocher-Langenbeck

(6.7%), and loss of reduction (3.3%). Shon et al.¹³from

approach was used; for anterior fractures (i.e., Anterior

wall or Anterior column fractures), the Ilioinguinal

approach was used, which is technically demanding.

For both column fractures, the modied Stoppa was

utilized. A professor of Orthopedics performed all

surgical procedures with at least 20 years of post-

Cheongju, Korea in their study conducted on 149

patients, in whom acetabular xation was done & found

that according to Matta‘s radiological outcome scale,

the radiological results were outstanding in 69 patients

(46.3%), good in 62 (41.6%), fair in 8 (5.4%), and bad

in 10 (6.7%). The Judet and Letournel classication and fellowship experience. Matta’s criteria for reduction of

the quality of reduction (p < 0.001) had an impact on

the functional result, with 121 patients (81.2%)

achieving excellent or good outcomes and 28 patients

(18.8%) achieving fair or poor outcomes. A lack of

awareness about the surgical outcomes of acetabular

fractures in patients presenting to Hayatabad Medical

Complex, Peshawar, was our research problem. Our

research will help surgeons understand the outcomes

following xation of acetabular fractures. The objective

of this study was to determine the outcomes of surgical

treatment in acetabular fractures.

acetabular fractures were used to assess structural

outcomes on the immediate postoperative day, using

plain radiographs AP & Judet views). Patients were

followed at 6 weeks, 3 months, and 6 months

postoperatively to assess functional outcomes using the

Harris Hip score. We included all patients who met the

inclusion criteria in our research. The patient’s age (less

than 45 years, 45-75 years, or older) and gender (male

or female) were our demographic factors, while the

presence of an acetabular fracture was our research

variable. All patients included in the study were

assessed by counts and percentages. Functional

outcome was assessed using the Harris Hip Score

grading system, and postoperatively, radiographs were

evaluated according to Matta‘s criteria. Three standard

radiographs were taken, i.e., AP pelvis, Obturator

oblique, and Iliac oblique for Matta‘s criteria. Every

collection technique was carried out under the guidance

of an orthopaedic professor and a qualied sta nurse.

IBM-SPSS-V.25 was utilized for data analysis. The

mean Harris hip score was compared between Group A

and Group B using a paired-samples t-test, and

structural outcomes were compared using Matta‘s score

between the groups using a paired-samples t-test. Data

is presented in tables and diagrams.

METHODOLOGY

This prospective observational study was conducted at

the Department of Orthopedics and Spine at Hayatabad

Medical Complex, Peshawar, Pakistan, from 1^stJanuary

2025 to 15^thOctober 2025. The hospital's ethical

committee granted study approval, Ref No. HMC-

QAD-F-00/1971, dated: 11-07-2024, and informed

consent was obtained from patients or their attendants.

Sample size was calculated using the Rao-soft sample

size calculator, and the consecutive non-probability

sampling technique was utilized. All adult patients of

either sex aged 18 to 75 years, with an acetabular

fracture with> 2 mm displacement of the articular

surface, <45º of Matta's roof arc angle, or a fracture

with instability aecting more than 20% of the

posterior wall, were included in the study. Patients unt

for surgery, having preoperative ipsilateral sciatic nerve

injury, hemiplegia, or acetabular fractures associated

with femoral head fractures were excluded from the

RESULTS

Out of 12 patients included in our study, 10 were men,

and 2 were women. 9 patients had an age of <45 years,

and 3 patients had an age of>45 years to 75years. 5

patients had anterior column fracture, 2 patients had

posterior wall & posterior column fracture, 2 had

transverse & posterior wall fracture, 2 patients had

bicolumnar fracture, 1 had anterior column & posterior

hemi-transverse. 12 patients included in the study

underwent surgery using an anterior or posterior

approach, depending on the type of fracture. Matta’s

criteria were used to assess the structural outcomes

post-acetabulum fracture xation. Of 12 patients, 9 had

excellent reduction, i.e., separation in acetabular

fractures was <1mm or none, while 2 had fair

study.

Structural

outcomes

were assessed

radiographs using Matta's criteria for reduction of

acetabulum fracture on Anteroposterior and Judet views

postoperatively. Separation up to 1mm was considered

excellent, 1-3mm as fair, and >3mm as poor reduction.

All preoperative patients with acetabular fractures who

met our inclusion criteria were assigned to Group A,

and all postoperative patients were assigned to Group

B. Functional outcome was assessed using the Harris

Hip Score, which includes pain and function (i.e., gait

and activities). Harris’ hip score was graded as follows:

90-100 as Excellent, 80-90 as Good, 70-80 as Fair, and

<70 as a poor outcome. All patients in the study

underwent surgery using dierent approaches. For

reduction, i.e., separation was 1 3 mm, and 1 had poor

reduction, i.e., separation in acetabular fractures was>3

mm. All preoperative patients were included in Group

A, and postoperative patients in Group B. Structural

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J Gandhara Med Dent Sci

Outcome of Surgical Treatment in Acetabular

outcomes between the groups were compared using a

Out of 12 patients included in our study 1 patient

developed hip AVN and required conversion to

secondary Total hip arthroplasty, two patients had

serous discharge from the wound site for which IV

antibiotics were given. No cases were reported having

sciatic nerve palsy or DVT.

paired-samples t-test to assess mean reductions; the

results were statistically signicant (p-value < 0.05).

Table 1: Paired sample t-test to compare the mean Matta’s score

at 6 weeks of follow-up

Mean Standar 95%

Valu e of

freed

Degre P-

d Deviat confidence

value

ion

interval of

the dierence

DISCUSSION

Lower Upper -3.5 10

0.005

In our study, it was found that surgical modality is the

treatment of choice for patients with acetabular

fractures who are candidates for surgical treatment, i.e.,

>2 mm displacement of the articular surface, <45º of

Matta's roof arc angle, or a fracture with instability

affecting more than 20% of the posterior wall.

Treatment for acetabular fractures must respect the

pelvic ring, since the acetabulum is a component of the

pelvis and its stability depends on the pelvic ring.^14,15

While primary repair is typically the initial surgical

option for young patients, this has not been established

for acetabular fractures in older individuals. For the

elderly, conservative treatment or ORIF plus primary

arthroplasty is often considered the treatment of

choice.^16,17Our study used Matta’s Criteria and the

Harris Hip Score to determine functional outcomes. Of

12 patients, 9 had excellent reduction, i.e., separation in

acetabular fractures was <1mm or none, while 2 had

fair reduction, i.e., separation was 1-3 mm, and 1 had

poor reduction, i.e., separation in acetabular fractures

was>3 mm. The results for acceptable structural

outcomes were statistically signicant (p-value < 0.05),

indicating eective surgical reduction. Harris Hip Score

was assessed at 6 weeks, 3 months, and 6 months

postoperatively to evaluate functional outcomes.

Paired-samples t-test showed satisfactory functional

outcomes, which were statistically signicant (p-value

< 0.05), indicating the eectiveness of surgical therapy

in the treatment of acetabular fractures at 6 weeks, 3

months, and 6 months. Similar to our study, Faizi et

al.12 from Kuala Lumpur, Malaysia, found that after

ORIF of acetabular fractures, 66.7% (20/30) of patients

showed excellent/good results, i.e., Harris Hip score ≥

80. Shon et al.¹³from Cheongju, Korea in their study

conducted on 149 patients, in whom acetabular xation

Group 12 6.00 1.1832 -4.81 -1.12

723

822

Group 12 1.0273 0.79258

Harris Hip Score was assessed postoperatively at 6

weeks, 3 months, and 6 months. Patients were divided

into two groups: Group A, preoperative patients &

Group B, postoperative patients. The mean Harris Hip

Score between the two groups was compared using an

independent-samples t-test at 6 weeks, 3 months, and 6

months. The results were statistically signicant (p-

value <), indicating the eectiveness of surgical therapy

in the treatment of acetabular fractures at 6 weeks, 3

months, and 6 months.

Table 2: Paired sample t-test to compare the mean Harris-hip

score at 6 weeks of follow-up

Mean Stand 95%

Degr

p -

ard

confidence

valu ee of

val

Devia interval of the

freed ue

tion

dierence

Lower Upper

Gro 12 26.2

8.012 -57.66 -32.00 -7.6 11

0.000

up A

500

097

569

Gro 12 71.0

17.25

up B

833

456

Table 3: Paired sample t-test to compare the mean Harris-hip

score at 3 months of follow-up

Mea Stand 95%

Degr p-

ee of val

freed ue

ard confidence

val

Devia interval of the

tion

dierence

Lower Upper

Gro

up A

12 26.2 8.012 -62.82 35.00

-7.7

0.000

500

494

839

Gro 12 75.1 18.61

was done

found that according to Matta's

up B

667

003

radiological outcome scale, the radiological results

were outstanding in 69 patients (46.3%), good in 62

(41.6%), fair in 8 (5.4%), and bad in 10 (6.7%). The

Judet and Letournel classication and the quality of

reduction (p < 0.001) had an impact on the functional

result, with 121 patients (81.2%) achieving excellent or

good outcomes and 28 patients (18.8%) achieving fair

or poor outcomes. Contrary to our study, McCormick et

al.18 found that, in the elderly population, older

patients treated with ORIF alone had a much greater

risk of complications than those treated with ORIF +

Table 4: Paired sample t-test to compare the mean Harris-hip

score at 6 months of follow-up

Mea Stand 95%

t -

Degr p-

ard confidence

val

ee of

val

Devia interval of the ue

freed ue

tion

dierence

Lower Upper

Gro

up A

26.2 8.012 -65.90 -36.09 -7.5 11

0.000

500

77.2 20.59

500 623

074

926

Gro

up B

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J Gandhara Med Dent Sci

Outcome of Surgical Treatment in Acetabular

Jee GM, Kumar N. Surgical treatment of acetabular fracture.

Int J Orthop Sci. 2022;8(1):67-71.

THA, THA alone, CRPP, or nonoperative treatment.

Elderly patients with acetabular fractures usually have

satisfactory functional outcomes despite having high

rates of mortality and morbidity. People undergoing

internal or percutaneous xation are frequently

converted to THA. Nonoperative therapy was

associated with the lowest risk of non-fatal

consequences and is still a viable option.

9. Milenkovic S, Mitkovic M, Stojiljkovic P. Total hip arthroplasty

after acetabular fracture surgery. Int Orthop. 2021;45:871-876.

https://doi.org/10.1007/s00264-020-04832-x. PMID: 33196874.

10. Ziran N, Soles GLS, Matta JM. Outcomes after surgical

treatment of acetabular fractures: A review. Patient Saf Surg.

2019;13:16. https://doi.org/10.1186/s13037-019-0196-2. PMID:

31139323.

11. Milenkovic S. Pelvic and acetabular fractures. Niš: Medical

Faculty, University of Niš; 2018.

12. Anizar-Faizi A, Hisam A, Sudhagar KP, Moganadass M, Suresh

C. Outcome of surgical treatment for displaced acetabular

LIMITATIONS

fractures.

Malays

Orthop

2014;8(3):1-6.

This study has several important limitations.

CONCLUSIONS

https://doi.org/10.5704/MOJ.1411.001. PMID: 25621033.

13. Shon HC, Lim EJ, Yang JY, Min CH. Outcomes of surgical

treatment of acetabular fractures with a minimum 1-year follow-

up.

Clin

Orthop

Surg.

2024;16(6):871-878.

https://doi.org/10.4055/cios23141.

A favourable structural and functional outcome can be

obtained with surgical therapy for displaced acetabular

fractures. Properly diagnose the fracture pattern, and

plan and perform the appropriate surgical approach

with careful procedural planning. Additionally, the

surgeon must inform patients about the risks and

potential outcomes of the procedure, especially if the

waiting time exceeds 2 weeks.

14. AlRousan FM, Almigdad AK, Jwinate MN, Aolymate MD,

Alsarhan FY, Al-Qudah OM. A review of acetabular fracture

patterns, etiologies, and management in Jordan. Saudi Med J.

2023;44(6):607-612.

https://doi.org/10.15537/smj.2023.44.6.20220931.

37343989.

PMID:

15. Khalifa AA, Kostadinov LJ, Hauri DD, Zhu TY. Health-related

quality-of-life, complications, and mortality rates after geriatric

acetabular fracture, nonoperative compared to operative

management: A systematic review and meta-analysis. Int J

Surg.

2025;111(10):7181-7201.

https://doi.org/10.1097/JS9.0000000000002776.PMID:

40540452

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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Waseem Khan - Concept & Design; Data Acquisition;

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Shah Hassan - Concept & Design; Data Acquisition;

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