Epidemiology, surgical management and outcomes of acetabular fractures at Tanzania’s national referral orthopaedic centre: A five-year retrospective study

Abstract

Background: Acetabular fractures are among the most complex injuries encountered in orthopaedic trauma, often resulting from high-energy mechanisms such as road traffic accidents, falls from height, or industrial injuries.Objective: Given the limited data from Tanzania, this study aimed to understand the epidemiological characteristics, patterns of surgical management, and early postoperative outcomes of patients undergoing operative treatment for acetabular fractures at Muhimbili Orthopaedic Institute.Methods: We conducted a retrospective cohort study of all patients who underwent surgical treatment for acetabular fractures over a five-year period (from January 2020 to December 2024). Data were collected using a standardised checklist. Analyses were conducted to determine burden, patient characteristics, associated injuries, time to definitive fixation and complications.Results: A total of 287 acetabular fractures underwent reconstruction over the 5-year period. The mean age was 36 years (range, 18-73 years), with a predominance of male patients (85.4%). The predominant mechanism of injury was motorcycle-related injuries (47.4%) followed by car occupants from road traffic accidents (30.7%). More than half (63.7%) of the patients had multiple injuries. Surgical fixation was performed via the Kocher–Langenbeck approach in the majority of patients (90.6%). Early complications included neuropraxia (17.2%), foot drop (4.6%), and surgical site infection (4.6%) while late complications included avascular necrosis (26.4%), osteoarthritis (12.6%) and myositis ossificans (5.7%).Conclusion: This study demonstrates a substantial burden of surgically managed acetabular fractures at Tanzania’s National Referral Orthopaedic Centre, predominantly affecting young, economically productive males following high-energy road traffic injuries, particularly motorcycle crashes. Although surgical fixation was achieved in all patients, considerable delays in referral and definitive fixation were observed, alongside early postoperative neurological and infective complications and important longer-term sequelae including avascular necrosis, post-traumatic osteoarthritis, and subsequent total hip replacement. These findings highlight the need for strengthened trauma referral systems and timely surgical intervention to improve outcomes in this setting.