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Central Acetabular Fracture Dislocations

- Discussion:
     - central frx/dislocation is crippling injury with a poor prognosis;
     - extensive degree of concomitant articular injury occurs;
     - 22% incidence of sciatic nerve injury;
     - distal and occassionally, lateral traction of proximal femur may be necessary to effect and maintain reduction of the femoral head;
     - total hip arthroplasty may be the treatment of choice;
- Types of Fractures:
       - undisplaced fractures (either single line or stellate types)
       - inner wall frx:
             - femoral head concentrically reduced beneath dome on initial films;
             - head not reduced under acetabular dome but centrally dislocated;
       - superior dome frx:
             - gross outline of acetabular dome intact & congruous w/ fem head
             - gross outline of acetabular dome not intact nor congruous w/ femoral head;
       - bursting frx (all elements of the acetabulum involved)
             - congruity remains between femoral head & acetabular dome
             - there is incongruity between femoral head & acetabular dome
- Treatment:
       - once the head/acetabular relationship is restored, pt is maintained in longitudinal traction for 10-12 weeks; 
       - lateral traction thru a trochanteric pin is used to reduce the joint and if necessary can be maintained for 8-10 weeks if necessary; 

- Complications:
       - infection in the retroperitoneal space:
       - central frx dislocation of femur is frequently accompanied by retroperitoneal bleeding;
       - if pin tract infection occurs around fixation device in greater trochanter, infection could spread to involve retroperitoneal space;
       - residual joint incongruity 

- References:

Internal fixation of osteopenic acetabular fractures involving the quadrilateral plate

The "Gull Sign": a harbinger of failure for internal fixation of geriatric acetabular fractures

Quadrilateral plate fractures of the acetabulum: an update.