Predictors of Clinical Outcomes In Surgically Treated Displaced Acetabular Fractures: A Single-Center Prospective Study

Dr. Rohit Tyagi — 2025-04-10

Background: Acetabular fractures represent challenging injuries requiring complex surgical interventions to restore joint congruity and function. This prospective study aims to evaluate the functional and radiological outcomes of surgically treated displaced acetabular fractures and identify factors that predict clinical results.

Methods: A prospective analysis of 118 patients with displaced acetabular fractures treated surgically at a single tertiary care center was conducted over an 18-month period. Patients were followed for 12 months postoperatively. Fractures were classified according to the Letournel and Judet system. Functional outcomes were assessed using the Modified Harris Hip Score, while radiological outcomes were evaluated using Matta's reduction criteria. Statistical analysis was performed to identify factors associated with clinical outcomes.

Results: The mean age was 41.36 years, with males comprising 73.7% of patients. Road traffic accidents (53.4%) were the predominant injury mechanism. Associated both-column fractures (25.4%) were most common, followed by T-type fractures (24.6%). The Modified Stoppa approach was most frequently employed (54.2%). According to the Modified Harris Hip Score, 48.3% of patients achieved excellent results, 34.7% good, 11.9% fair, and 5.1% poor. Anatomical reduction (<1mm displacement) was achieved in 65.3% of cases. Marginal impaction (p=0.01), initial displacement magnitude (p=0.02), and quality of reduction (p=0.001) showed significant associations with functional outcomes. However, demographic factors, fracture patterns, and surgical approaches did not significantly influence results.

Conclusion: Surgical management of displaced acetabular fractures yields favorable outcomes in the majority of cases. The quality of reduction is the most critical determinant of functional recovery, emphasizing the importance of anatomical reduction as the primary surgical objective. Marginal impaction and initial displacement magnitude are additional important predictors of outcome. These findings highlight key factors that surgeons should consider when managing these complex injuries to optimize patient recovery.

Precision Anesthesia: Nalbuphine-Levobupivacaine vs. Fentanyl-Levobupivacaine in Spinal Blocks

Dr. Misra Jasmeen — 2025-04-10

Background: Intrathecal adjuvants enhance the efficacy of local anesthetics in spinal anesthesia. This study compared nalbuphine and fentanyl as adjuvants to hyperbaric levobupivacaine for lower abdominal surgeries.

Methods: In this prospective, randomized, double-blind study, 100 ASA I-II patients undergoing lower abdominal surgeries were allocated into two groups: Group LN (n=50) received 15 mg of 0.5% hyperbaric levobupivacaine with 0.8 mg nalbuphine intrathecally, and Group LF (n=50) received 15 mg of 0.5% hyperbaric levobupivacaine with 25 μg fentanyl intrathecally. Onset and duration of sensory and motor blockade, hemodynamic parameters, postoperative analgesia using Visual Analog Scale (VAS), and adverse effects were assessed.

Results: The onset of sensory block (2.795±0.599 min in Group LN vs. 2.625±0.562 min in Group LF; p=0.921) and time to complete motor block (10.38±1.081 min vs. 10.59±1.004 min; p=0.766) were comparable between groups. The duration of sensory block (282.29±23.09 min vs. 306.88±29.06 min; p=0.0001) and motor block (178.46±7.59 min vs. 242.96±39.17 min; p=0.0001) were significantly longer in Group LF. VAS scores were significantly lower in Group LN at 1.5, 2, 2.5, and 3.5 hours postoperatively (p<0.05). Hemodynamic parameters remained largely stable in both groups. The incidence of adverse effects was comparable, with pruritus observed exclusively in Group LF (4%).

Conclusion: Fentanyl provided prolonged sensory and motor blockade, while nalbuphine offered better early postoperative analgesia with faster motor recovery and absence of pruritus. Both adjuvants maintained hemodynamic stability with minimal adverse effects, suggesting their selection should be tailored to specific surgical requirements and desired recovery profiles.

Medico Research Chronicles

Predictors of Clinical Outcomes In Surgically Treated Displaced Acetabular Fractures: A Single-Center Prospective Study

Precision Anesthesia: Nalbuphine-Levobupivacaine vs. Fentanyl-Levobupivacaine in Spinal Blocks