Madelene Albrektsson: Classification, treatment, and results of acetabular fractures
Acetabular fractures most commonly affect older and men who have experienced a low-energy trauma. Most are treated nonoperatively, but some require surgery. The thesis highlights the classification, treatment, and outcomes for this patient group. It further confirms that most patients experience some level of functional impairment one year after the injury.
MADELENE ALBREKTSSON
Dissertation defense: 7 March 2025 (click for details)
Doctoral thesis: On the classification, epidemiology, and outcome of acetabular fractures
Research area: Orthopaedics
Sahlgrenska Academy, The Institute of Clinical Sciences
Madelene Albrektsson’s doctoral thesis focuses on patients who have sustained an acetabular fracture - the part of the hip joint that sits within the pelvic bone. This injury occurs when the femoral head is forced into the acetabulum. Younger individuals typically suffer this injury due to severe accidents, whereas older patients may experience fractures from a standing-height fall, often due to underlying osteoporosis.
Acetabular fractures affect between 3 and 11 individuals per 100,000 people each year. They can be highly debilitating and often lead to long-term complications. Over the past 60 years, new treatment options have emerged, highlighting the need for research on treatment outcomes.
"We have mapped this type of fracture, and the patients affected and described the treatment outcomes following an acetabular fracture. The four studies in this dissertation are based on data from the Swedish Fracture Register (SFR)," says Madelene Albrektsson, senior orthopaedic surgeon at the Orthopaedic Department, Sahlgrenska University Hospital and a doctoral student at the Institute of Clinical Sciences.
The Swedish Fracture Register (SFR) – a valuable tool for research
The first study evaluates how acetabular fractures are classified in the SFR to determine the register’s usability.
"The study shows an acceptable level of agreement in fracture classification within the SFR, making it a valuable tool for research."
The second study reveals that most patients with an acetabular fracture are men, are over the age of 70 and who sustained the injury from a simple fall. Furthermore, the mortality rate is as high as that of hip fractures.
Worst functional outcomes in younger patients with high-energy trauma
The third study examines patient-reported outcome measures (PROM) related to functional impairment one year after injury compared to pre-injury levels.
"PROM data show that most patients experience a decline in function one year after their injury. The most significant deterioration is seen in patients with more severe fractures caused by high-energy trauma, particularly among younger individuals, younger than 70 years."
The fourth study investigates the need for additional surgery after initial treatment. The findings show that after five years, 17% of patients who underwent open reduction and internal fixation (ORIF) required secondary treatment with hip arthroplasty.
"If we can identify patients at the highest risk of needing a joint replacement later, we can offer them primary arthroplasty treatment immediately after their injury. This could spare them from prolonged pain and an additional operation.
A rewarding research journey
What has been the most rewarding and challenging aspect of your doctoral research?
"I found the doctoral program highly rewarding, as it gave me a deeper understanding of the complexity of data interpretation and the conclusions that can—or in many cases, cannot—be drawn. One of the challenges in this project has been processing the collected data and determining what and how to present it in the best way."
Text: Susanne Lj Westergren