Injury - 2026-04-08 - Journal Article
Patient and fracture characteristics associated with six-month patient-reported outcomes following acetabular fracture fixation.
Bhatti HS, Litten RM, McConnell MJ, McIlwain RN, North DD, Spitler CA, Johnson JP
Topics
Key Takeaway
At 6 months post-acetabular ORIF, female sex and nonwhite race—not fracture complexity or ISS >16—independently predicted worse PROMIS scores across multiple domains including pain interference, global physical health, depression, and anxiety.
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Summary
This single-center retrospective study evaluated demographic, injury, and fracture characteristics associated with 6-month PROMIS PROs in 109 adults undergoing operative acetabular fracture fixation. On adjusted analysis, female sex was independently associated with higher pain interference, worse global physical health, higher depression, and lower percent of normal function; nonwhite race was independently associated with worse global physical health, worse global mental health, higher anxiety, higher pain interference, and lower Brief Resilience Scale scores. Fracture pattern (elementary vs. associated per Judet-Letournel) and polytrauma status (ISS >16) were not significant predictors after adjustment.
Key Limitation
Absence of socioeconomic, insurance, and rehabilitation access data prevents determining whether the race and sex effects reflect biological differences or structural disparities in postoperative care.
Original Abstract
INTRODUCTION
Patient-reported outcomes (PROs) after acetabular fracture fixation vary widely, and the influence of demographic, injury, and fracture characteristics on early recovery remains incompletely defined. This study evaluated factors associated with six-month PROs following operative fixation of acetabular fractures. The authors hypothesized that greater injury burden, as measured by Injury Severity Score (ISS), and more complex fracture patterns would be associated with worse six-month PROs.
METHODS
Adult patients who underwent operative fixation of acetabular fractures (AO/OTA 62) at a single Level I trauma center (June 2022-October 2024) were retrospectively identified. Patients completing six-month Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function [PF], Pain Interference [PI], Global Physical Health [GPH], Global Mental Health [GMH], anxiety, depression), Brief Resilience Scale (BRS), and percent of normal function surveys were included. PROs were compared by sex, race, fracture pattern (elementary vs associated), and polytrauma status (ISS > 16). Unadjusted and adjusted analyses were performed controlling for age, sex, race, Letournel classification, concomitant infection, and other orthopaedic injuries.
RESULTS
A total of 109 patients completed six-month surveys (mean age 50.6 years; 64.2% male). On unadjusted analysis, female patients reported higher PI (62.5 vs 58.8, p = 0.032) and higher depression (58.1 vs 51.7, p = 0.009). After adjustment, female sex remained associated with higher PI (p = 0.012), worse GPH (p = 0.029), higher depression (p = 0.032), and lower percent of normal (p = 0.037). Nonwhite patients demonstrated worse unadjusted GPH (39.0 vs 43.0, p = 0.028), worse GMH (41.5 vs 46.6, p = 0.018), higher anxiety (58.9 vs 51.4, p = 0.005), and lower BRS (3.2 vs 3.7, p = 0.032). After adjustment, nonwhite race remained associated with worse GPH (p = 0.014), worse GMH (p = 0.029), higher anxiety (p = 0.050), higher PI (p = 0.039), and lower BRS (p = 0.050). No significant differences were observed by polytrauma status or fracture pattern.
CONCLUSION
At six months following acetabular fracture fixation, female sex and nonwhite race were associated with worse PROs across multiple domains, while fracture pattern and polytrauma status were not significant after adjustment.