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/ /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, ……

The fracture can be seen in X-ray which will be done as apart of the examination of multitrauma pt.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.

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 involving both collumns Both columns resulting in floating acetabulum. Or much more complex fracture, more components fracture.

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.

Certain criteria to get success in conservative treatment: 1.when the traction released the hip joint remain congruent. 2.weightbearing roof should be intact. 3.assosiated fractures of the post. Wall should be excluded by CT.

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. Taking care of the nerves and blood vessels, too much incision lead to more fibrosis and ossification around the joint. In some cases may be indomethacin indicated to about 3 monthes in low dosis to prevent ossification. Repostion will be done and fixation by screw or plate. A number of these patients will end with OA of the hip or head necrosis of the femur even when the correct reposition and fixation done. The aim of operation is to make astable hip with significant distoration of the ball and socket congruence.

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. Periarticular ossification, prophylactic indomethacin is good. Avascular necrosis. Secondary osteoarthritis is common.

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.