Pre-operative predictors of poor reduction in acetabular fractures submitted to surgical treatment

•The success of acetabular displaced fractures surgical treatment is influenced by preoperative factors.•The use of Verbeek criteria for articular step and gap measures over Matta criteria for radiographic reduction provided some distinct results from those found in the literature.•Time to surgery, associated fracture pattern, >3 associated fractures, and pelvic injury increased the likelihood of unsatisfactory reduction.•Although increased age and initial displacement may increase surgical technical difficulty, they did not have a significant impact on reduction quality.•Because time to surgery is the only factor in which surgeons can intervene, focus should be given to implementing early intervention strategies. Acetabular fractures are among the most complex orthopedic injuries, and their treatment and understanding have evolved remarkably in the last 50 years. Several factors affect the reduction quality of the surgically treated displaced acetabular fractures. Thus, this study aimed to identify these factors by analyzing patients’ data. Retrospective data from fractures operated in one center over 8 years were analyzed. Patients with a mature skeleton who underwent open reduction and internal fixation and had a minimum follow-up period of 6 weeks were included. Non-displaced fractures were excluded from the study. Radiographic assessment of the reduction was performed before surgery and at follow-up using the method described by Borelli et al. The effects of age (40 years), sex, initial displacement (< 20 mm or > 20 mm), time to surgery (14 days), fracture pattern (elementary or associated), number of associated fractures (< 3 or > 3), and associated pelvic injury were analyzed The study included 115 (83.9%) men and 22 (16.1%) women, with a mean age of 34.1 years (range 16–74 years). In the sixth week of follow-up, reductions were satisfactory in 96 (70.7%) patients and unsatisfactory in 41 (29.3%). The most prevalent patterns were the posterior wall (23.1%) and both column (15.7%). Linear regression showed that residual displacement was directly correlated with initial displacement (p = 0.027) but without association with reduction quality. Age, sex, and initial displacement had no effect on reduction quality, which is in contrast with longer time to surgery (p = 0.004), associated fracture pattern (p = 0.002), three or more associated fractures (p = 0.001), and presence of associated pelvic injury (p = 0.021). Attempting to short