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The Journal of Bone and Joint Surgery (American) 85:1879-1883 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Functional Outcomes of Acetabular Fractures

Berton R. Moed, MD, Paul H. Yu, BA, MPH and Konrad I. Gruson, MD

Investigation performed at Wayne State University School of Medicine, Detroit, Michigan

Berton R. Moed, MD
Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, Desloge Towers, 7th Floor, St. Louis, MO 63110.

Paul H. Yu, BA, MPH
Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI 48201

Konrad I. Gruson, MD
New York University School of Medicine, 550 First Avenue, New York, NY 10016

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive 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, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The Musculoskeletal Function Assessment is a validated, well-designed, self-administered questionnaire that is useful for determining health status. The modified Merle d'Aubigné clinical hip score is the most generally accepted clinical grading system for evaluating the results of acetabular fracture treatment. The purpose of the present study was to evaluate the relationship between the Musculoskeletal Function Assessment and modified Merle d'Aubigné scores in evaluating the results of acetabular fracture treatment.

Methods: One hundred and fifty patients with an acetabular fracture met the criteria for inclusion in the present study, which included a minimum of two years of postoperative follow-up, a complete physical examination with use of the Merle d'Aubigné score, and successful completion of the Musculoskeletal Function Assessment questionnaire. Patients were stratified according to a number of factors, including the type of fracture and whether the fracture was an isolated injury or was part of a multiple-injury complex. The mean duration of follow-up was five years (range, two to seventeen years).

Results: The mean modified Merle d'Aubigné score was 16.8 (range, 9 to 18), and the mean Musculoskeletal Function Assessment score was 24.9 (range, 0 to 79). The Spearman correlation coefficient between the Merle d'Aubigné score and the Musculoskeletal Function Assessment score was -0.61 (p < 0.0001). Stratification of the patients did not alter these overall results. However, the presence or absence of associated injuries was a significant factor for the Merle d'Aubigné score (p = 0.03). In addition, the Merle d'Aubigné score data were asymmetric, demonstrating a ceiling effect.

Conclusions: The Musculoskeletal Function Assessment scores for these patients were relatively high compared with those for the normal population, indicating that complete return to a preinjury functional level is uncommon despite a good-to-excellent Merle d'Aubigné clinical score. Furthermore, the ceiling effect demonstrated by the Merle d'Aubigné score (despite its high correlation with the Musculoskeletal Function Assessment score) limits its usefulness as a method for evaluating the outcome of treatment of acetabular fractures. There have been few published clinical studies in which the Musculoskeletal Function Assessment score has been used as an outcome measure, and reference values are lacking. The present study provides initial guideline reference values for use in the evaluation of patients following an acetabular fracture.


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