FRACTURES OF ACETABULUM

Nomin-Erdene.D

• Occurs when the head of the femur is driven into the pelvis.

• Combine with complexities of pelvic fractures and joint disruption

Patterns of the fracture

• 1. Anterior wall• 2. Anterior column• 3. Posterior wall• 4. Posterior column• 5. Transverse column• 6. T-shaped fracture

Clinical features

• Severely shocked• Severe pain• Bruising around the hip and limb • No attempt should be made to move the hip• Do neurological exam

Imaging

• At least 4 x-ray views– AP view– Pelvic inlet view– Two 45 degrees oblique

view

Treatment

Emergency treatment

Non-operative

Operative

Emergency treatment

• The first priority is to counteract shock and reduce a dislocation.

• Skeletal traction is then applied to the distal femur (10 kg will suffice) and during the next 3–4 days the patient’s general condition is brought under control.

• Occasionally, additional lateral traction through the greater trochanter is needed for central hip dislocations.

Non-operative treatment

• Walking aids. To avoid bearing weight on your leg: use crutches or a walker for up to 3 months—or until your bones are fully healed.

• Positioning aids. May restrict the position of your hip, limiting how much you are allowed to bend it. A leg-positioning device, such as an abduction pillow or knee immobilizer.

• Medications. NSAID, an anti-coagulant

Operative treatment

• Timing of surgery – few days until stable• ORIF• THR

Complication

Iliofemoral venous

thrombosis

Sciatic nerve injury

Heterotopic bone

formation

Avascular necrosis Secondary OA