Impact of delay from trauma to surgery on radiological and functional outcomes in posterior wall acetabular fractures treated by open reduction and internal fixation

Background: Posterior wall acetabular fractures are the most common acetabular subtype and often result from high-energy trauma in young adults. Surgical timing and reduction quality are thought to influence prognosis, but evidence specific to posterior wall fractures remains limited. Methods: This prospective observational study included 20 patients with posterior wall acetabular fractures treated by open reduction and internal fixation (ORIF) at Dhaka Medical College Hospital between August 2020 and March 2022. Demographic, injury-related, and operative variables were recorded. Outcomes were assessed using the Matta radiographic criteria and Merle d’Aubigné-Postel functional scores. Statistical associations were analyzed using chi-square or Fisher’s exact tests. Results: The mean age was 38.3±10.2 years; 90% were male, and 90% sustained injuries from road traffic accidents. The mean trauma-to-surgery delay was 12.8±3.6 days. Anatomical reduction was achieved in 80%. Radiological outcomes were excellent or good in 85%, while functional outcomes were excellent or good in 90%. Overall, 90% achieved satisfactory results. Surgical delay >15 days was significantly associated with poorer functional (p=0.036) and overall outcomes (p=0.012). Anatomical reduction significantly predicted excellent outcomes across all domains (p<0.05). Hip dislocation, gross fragment displacement, and abdominal injury were additional predictors of poor results. Complications were rare (20%). Conclusions: Early surgical intervention and anatomical reduction are essential for optimizing radiological, functional, and overall outcomes in posterior wall acetabular fractures. Delay beyond two weeks and poor reduction quality substantially compromise recovery.