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Fractures of the Acetabulum

Fractures of the Acetabulum. Dr Bakhtyar Baram. May be apart of alarger fracture in the pelvis or other regions like in the multitrauma pt.s . About 3/100 000/ year in Europa.

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Fractures of the Acetabulum

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  1. Fractures of the Acetabulum Dr BakhtyarBaram

  2. May beapart of alargerfracture in the pelvis or other regions like in the multitraumapt.s. • About 3/100 000/year in Europa. • May cause permanent problem in the future like OA in the joint if they don’t get the correct treatment from the bigining. • Clinically in the trauma pt.s, fall from height , car accident, etc, pain and tenderness in the region, asymmetric sides, shortening of the leg, pain during movement and examination, ……

  3. The fracture can be seen in X-ray which will be done as apart of the examination of multitraumapt.s , the fracture line can be seen , AP view, and today CT scan can be made instead of oblique views which will show clearly the fracture lines and a correct classification can be done. • 3D reconstruction views will show it obviosly.

  4. classification • May be , simple post. Or ant. Wall fracture, may affect apart of the roof. • May affeect the depth of the socket and lead to instability of the joint and osteoarthritis. • Ant. Or post. Collumn • Transverse • T type involvingbothcollumns • Both columns resulting in floatingacetabulum. • Or much more complex fracture , more components fracture.

  5. treatment • Reduction of the dislocation by even skin or skeletal traction will give relaxation and immobilization which lead to reduction of pain, and easier reduction during operation after few days. • In cases of any sign of nerve compression, sciatic or lumbosacral plexuses, an acute operation will be indicated, or in case of isolated post. Wall fracture and dislocation. • Normally reduction and fixation can be performed after few days if it is indicated. • Indication for non-operative treatment is, A: less than 3 mm displacement in the wightbearig area. B:not involving the roof area, i.e. distal ant. Column or distal transverse. C: the ball and the socket congruence is not affected, intact labrum. D: old ages .E:medical contraindications.

  6. Certain criteria to get success in conservative treatment: • 1.when the tractionreleased the hip joint remaincongruent. • 2.weightbearing roofshouldbeintact. • 3.assosiated fractures of the post. Wall shouldbeexcluded by CT.

  7. Operative treatment need to do the correct incision depending on the site of the fracture, ant. Or post. Incision or may be combined or T incision, or more. • Takingcare of the nerves and blood vessels, toomuchincisionlead to more fibrosis and ossificationaround the joint. In some cases maybeindomethacinindicated to about 3 monthes in low dosis to preventossification. • Repostionwillbe done and fixation by screw or plate. • A number of these patients will end with OA of the hip or head necrosis of the femurevenwhen the correctreposition and fixation done. • The aim of operation is to make astable hip with significantdistoration of the ball and socketcongruence.

  8. complications • Illiofemoral venous thrombosis, prophylactic anticoagulation indicated. • Sciatic nerve injury, may be at the time of the trauma or the operation, pre-operative good estimation is necessary. If there is damage, better to wait 6 weeks , if stilll persisting , exploration may be needed. • Periarticularossification, prophylacticindomethacin is good. • Avascularnecrosis. • Secondaryosteoarthritis is common.

  9. Traumatic hip dislocation • Normally need a high power to occure, like trafik accident, adirect power anteriorly from the shaft of femur which lead to the dislocation with the fracture of the post. Wall of the acetabulum or not, there may be fracture of the shaft of the femur at the same time. • Direct trauma on the trochanter region may push the head of the femur to the pelvic cavity. • May be the dislocation anteriorly in some cases. • Clinically there may be shortening the leg with rotation internally or externally depending on the type of the dislocation. there is tenderness and pain • X ray will easily show the diagnosis, CT may be indicated in case of fracture. • Treatment is acute reposition under GA and fixation may be indicated in case of the fracture, bed rest for 1-2 week. • Non weight bearing exercise after that for weeks. • Traction may be indicated in case of instability.

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