Fractures of the Acetabulum

(see also: Pelvic Frx; Radiographs; Work Up and Treatment)

• Anterior Column Frx
• Anterior Wall Fractures
• Both Column Frx
• Central Acebular Fracture Dislocations
• Classification and Column Theory
• Displaced Dome Fractures
• Heterotopic Ossification
• Hip Frx
• Fracture Dislocations of the Hip
• Judet View
• Iliofemoral Approach to the Acetabulum
• Ilioinguinal Approach to the Acetabulum
• Pediatric Acetabular Fractures
• Posterolateral Approach: (Kocher Langenbach)
• Posterior Column Frx
• Posterior Wall Fractures
• Radiology of the Acetabulum
• Reduction
• T Shaped Fractures
• Total Hip Replacement for Acetabular Fractures
• Transverse Fractures of the Acetabulum
• Triradiate Approach
• Two-Column Fractures

Classification and Column Theory »

elementary frx:

• account for about 20% of acetabular frx;
• anterior wall
• anterior column:
  • bony strut running from ASIS to superior pubic ramus, & includes anterior wall;
  • iliopectineal line is involved;
• transverse frx
  • involve both anterior & posterior acetabulum: dividing the innominate bone into superior segment containing acetabular roof & intact ilium, & inferior segment consisting of single ischiopubic fragment;
• posterior wall
  • frxs always involve posterior articular surfaces, often accompanied by a portion ofretroacetabular surface and sometimesentire surface;
• posterior column
  • bony strut running from PSIS to inferior pubic ramus, & includes posterior wall;
  • involves not only the posterior articular surfaces, but also the ilioischial line;

associated frx types:

• account for about 80% of acetabular frx;
• are composed of two or more of the elementary fracture patterns;
• many assoc frx types, esp two-column frx, require more extensive exposures than are achieved by either ilioinguinal or posterolateral approach alone;

five patterns include:

1. posterior column + posterior wall fractures
2. transverse + posterior wall frx;
3. anterior column + anterior wall plus associated w/ posterior hemitransverse fractures;
4. T-shaped fracture;
5. both column frx: this is the most common frx type (about 35% of acetabular frx);

References for Surgical Exposure

• A modified extensile exposure for the treatment of complex or malunited acetabular fractures.
• Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure.
• Non-extensile surgical approaches for two-column acetabular fractures.
• The triradiate incision for acetabular fractures. A prospective study of 23 cases.
• Management of complex acetabular fractures through single nonextensile exposures.
• Acetabular fracture fixation via Stoppa limited intrapelvic approach. Description of operative technique and treatment results.
• Surgical revision of malreduced acetabular fractures.
• Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum.
• The use of trochanteric slide osteotomy in the treatment of displaced acetabular fractures.
• Osteotomy of the Trochanter in Open Reduction and Internal Fixation of Acetabular Fractures.
• Modified Ollier Transtrochanteric Approach for the Treatment of Acetabular Fractures

Additional Reading

• A Sobering Message to Acetabular Fracture Surgeons
• Predictors for Long-Term Hip Survivorship Following Acetabular Fracture Surgery
• Fractures of the Acetabulum: accuracy of reduction and clinical results in patients managed operatively with in three weeks after the injury.
• Fractures of the acetabulum. Early results of a prospective study.
• Displaced acetabular fractures
• Complex acetabular fractures.
• Stabilization of acetabular fractures in elderly patients.
• Results in patients with craniocerebral trauma and an operatively managed acetabular fracture.
• Results of 75 consecutive patients with an acetabular fracture.
• Fractures of the acetabulum. A study of a series of 75 cases. 1961
• A prospective study of surgically treated acetabular fractures.
• Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures.
• Delayed reconstruction of acetabular fractures 21-120 days following injury.
• Fractures of the Acetabulum.
• The Efficacy of Routine Postoperative CT Scan after ORIF of the Acetabulum.

Tips & Techniques

• New Tool for Applying Traction During Open Reduction and Internal Fixation of Acetabular Fractures