"The double impact: insights into bilateral acetabulum fractures".

backgroundBilateral acetabular fractures resulting from trauma are rare and complicated, owing to the distinct forces involved and the unique patterns of the fractures. Despite the severity of these injuries, literature on bilateral acetabular fractures remains limited, with most studies focusing on unilateral cases. Consequently, there is a lack of comprehensive data regarding the optimal treatment protocols, expected functional outcomes and long-term prognosis for patients with bilateral involvement. This study was undertaken to address this gap by systematically evaluating both radiological and functional outcomes in patients with bilateral acetabular fractures. MATERIALS AND

methodsThis prospective study conducted over period of 3 years from Jan 2022 to Jan 2025 included 410 patients with pelvic and acetabular fractures, of whom 274 had acetabular fractures, including 24 cases (8.8%) with bilateral involvement. Demographic details and the mechanism of injury were documented. One patient of polytrauma expired postoperatively due to sudden cardiac death and was excluded from follow up. Functional outcomes were assessed at 3 and 6 months using the Harris Hip Score (HHS), and Merle d’Aubigné score. Radiological outcomes were evaluated through CT-based analysis of residual step and gap deformities with fracture reduction graded according to Matta’s criteria.

resultsThe mean age of patients was 39.08 ± 16.08 years, with males comprising 75% of cases (n = 18) of the cohort. Road traffic accidents (RTAs) were the most common mechanism of injury, accounting for 16 (66.7%) of cases. The anterior column was the most frequently involved fracture type on both sides. Mean duration of hospital stay was 17.22+/− 11.63 (6–61) days. The earliest a patient could be operated was 2 days and the maximum delay in acetabular surgical intervention was 31 days. Average no. of pelvi-acetabular fracture intervention was 1–2 and average no. of surgical intervention for polytrauma was 3–4. Based on Matta’s criteria (step displacement), anatomical reduction (</=1 mm step) was achieved in 5 patients, while 18 patients demonstrated near anatomical reduction (1–3 mm step). According to Matta’s criteria (gap displacement), 0 patients achieved anatomical reduction (</= 1 mm gap), 11 patients had near anatomical (1–3 mm gap) reduction and 12 had non anatomical reduction (> 3 mm gap). Out of the 24 Patients 18 patients underwent open reduction and internal fixation on single side whereas 4 patients underwent surgery bilaterally and 2 patients underwent conservative management for both sides. A significant improvement was observed in both Harris Hip Score (HHS) and Merle d’Aubigné Score (MDAS) between the 3-month and 6-month follow-ups. The improvement in scores varied with step and gap in reduction.

conclusionRadiological findings demonstrated a significant positive correlation with functional recovery. Anatomical or near-anatomical reduction was associated with superior clinical outcomes. These findings provide insight into this rare injury pattern and highlight the importance of achieving accurate fracture reduction. Further studies with larger sample sizes and longer follow-up are required to validate these observations.