ACETABULAR FRACTURE

CHETAN NARRA

• In the elderly patient (defined as more than 60 years of age), the most common mechanism of injury is a fall (mostly it is an isolated injury)

• for a younger patient, in whom a motor vehicle accident is the most common

Letournel and judet attain the best results, hip joint congruity and stability must be accompanied by an anatomic (defined as less than 2 mm of residual displacement) reduction of the displaced articular surface.

open anatomic reduction and internal fixation continue to serve as the mainstays in the treatment of displaced fractures of the acetabulum

elderly patients (defined as patients aged 60 and older) using minimally invasive reduction and percutaneous fixation

MECHANISMS OF INJURY

• Fractures of the acetabulum occur by impact of the femoral head with the acetabular articular surface.

• This force to the femoral head may be applied via the greater trochanter (along the axis of the femoral neck) or from anywhere along the long axis of the femoral shaft.

Neutral rotation causes a transverse #

external hip rotation will produce an anterior #

internal rotation will produce a posterior #

• fracture types most commonly sustained by the elderly are those involving the anterior column and/or wall, which are caused by a fall on the greater trochanter.

• low-energy injuries usually produce isolated fracture,

• whereas high-energy injuries mostly in young are often associated with additional skeletal or other system trauma (where posterior wall fracture is most common)

ASSOCIATED INJURIES

• lower extremity fracture was found to be the• most commonly associated injury (36%), followed by injuries• to the lungs, retroperitoneum, and upper extremities

SIGNS AND SYMPTOMS

• Local closed degloving soft tissue injuries about the hip (the Morel–Lavallé lesion) can harbor pathogenic bacteria and lead to wound breakdown and deep infection.

• Therefore, debridement followed by delayed wound closure and, subsequently, delayed fracture fixation may be required., More recently, a percutaneous method of debridement has been described

NEUROLOGICAL EXAMINATION

• Sciatic nerve injury is common in fractures with a posterior hip dislocation and fracture displacement of the posterior wall or column.

• It is often incomplete, most often involving the peroneal division.

• it is important to evaluate the patient’s ability to perform active ankle dorsiflexion in addition to toe dorsiflexion

Columns of the innominate bone Letournel and Judet

(a) iliopubic or iliopectineal line(b) ilioischial line, formed by the posterior portion of the quadrilateral plate (surface) of the iliac bone; (c) teardrop, formed by the medial acetabular wall, the acetabular notch, and the anterior portion of the quadrilateral plate; (d) roof of the acetabulum; (e) anterior rim of the acetabulum; (f) posterior rim of the acetabulum.

TRANSVERSE FRACTURE• The fracture separates the innominate bone into two pieces: The upper iliac

piece and the lower ischiopubic segment.• Transverse fractures are subdivided by where the fracture crosses the

articular surface. • Transtectal fractures cross the weight-bearing dome of the acetabulum. • Juxtatectal fractures cross the articular surface at the level of the top of the

cotyloid fossa. • Infratectal fractures cross the cotyloid fossa

• Operative treatment of acetabular fractures should not be performed as an emergency

• Except

• Operative treatment is indicated for all acetabular fractures that result in hip joint instability and/or incongruity, regardless of the classification type.

• Osteoporosis precluding adequate fracture fixation and fractures in the geriatric population are commonly cited as relative contraindications to open reduction and internal fixation

FACTORS WERE IDENTIFIED THAT WERE PREDICTIVE OF THE NEEDFOR EARLY CONVERSION TO TOTAL HIP ARTHROPLASTY