Demographic, surgical, and radiologic determinants of patient-reported outcomes, hospitalization, and return to work after acetabular fracture ORIF: a tertiary trauma center experience with a minimum two-year follow-up

Acetabular fractures are complex injuries with substantial potential impact on function, quality of life, and return to work. This study evaluated demographic, radiologic, and surgical determinants of mid-term patient-reported outcomes, hospitalization, and vocational recovery after open reduction and internal fixation (ORIF).

In this retrospective cohort, patients undergoing acetabular ORIF with ≥ 2-year follow-up and complete radiographic/clinical records were included. Outcomes included the modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF-12 (PCS-12/MCS-12), length of stay (LOS), time to return to work (RTW), and RTW status. Analyses were adjusted for baseline comorbidity using the Charlson Comorbidity Index (CCI), using ANCOVA.

Forty-two patients were analyzed (mean age 35.60 ± 13.12 years; 73.8% male), with a mean follow-up of 35.86 ± 6.89 months. Mean mHHS and WOMAC were 77.79 ± 19.17 and 24.52 ± 9.54, respectively. Mean length of stay and return-to-work (RTW) were 6.52 ± 3.11 days and 6.54 ± 4.67 months, respectively (66.7% returned to a similar activity level). After adjustment, anatomic reduction quality was significantly associated with the mHHS function subscale (P = 0.005) and shorter hospitalization (P < 0.001). Femoral head injury (FHI) was associated with worse WOMAC total (P = 0.019). Comminution was associated with PCS-12 (P = 0.028) and longer LOS (P = 0.007). Associated fracture patterns were linked to prolonged LOS (P = 0.006). No variable significantly predicted RTW time/status.

Mid-term outcomes after acetabular ORIF were generally acceptable. Reduction quality showed consistent associations with functional outcome and hospitalization burden, while FHI was associated with worse patient-reported disability. Several radiologic predictors influenced hospitalization burden more than late patient-reported outcomes.