Acetabular fracture


Occur mainly in young adults as a result of high-velocity trauma.

Often associated with other life-threatening injuries.

Cause internal bleeding from the broken bone and the surrounding injured soft tissues.

May be associated with damage to internal organs, such as the bowel or bladder.

Neural injury may cause sensory loss and muscle dysfunction to the leg or that control bowel, bladder and sexual function.

Displacement of the fracture fragments leads to abnornmalities on the articular cartilage surface resulting in arthritis of the hip joint.

Reduction and stable fixation of the fracture is the treatment goal.

Usually occur as a result of high-velocity injury and often affect the young.

An intra-articular fracture.

Can lead to intra-articular malunion and joint incongruity, destruction of the articular cartilage and hip arthritis.

Trauma centers have shown an admission rate for pelvic and acetabular fractures of 0.5-7.5%.

About 24% of adult pelvic fractures are acetabular in nature and 5-10% of pediatric pelvic injuries involve the acetabulum.

Secondary to high-velocity trauma, such as vehicular accidents or falls from heights where force exerted through the head of the femur to the acetabulum.

Femur position, at the time of impact, and the direction of the force determine the type and displacement of the fracture.

Force applied to the greater trochanter in the axis of the femoral head

The point of impact of the femoral head is related to the degree of adduction and abduction and rotation of the femur.

The type of acetabulum fracture depends on the degrees of flexion or extension and adduction or abduction.

Classification is based on acetabular fracture morphology: posterior wall fractures, posterior column fractures, anterior wall fractures, anterior column fractures, transverse fractures, anterior and posterior hemitransverse fractures, posterior lip and posterior column fracture, posterior wall with posterior column fracture, transverse with posterior wall fracture, T-shaped fracture, and both columns fracture.

Other classification include Type A fractures – Involving either a single wall or column, Type B fractures – Include both anterior and posterior columns but not bicolumnar fractures (transverse, T-shaped, anterior with posterior hemitransverse type injuries), and Type C fractures – Bicolumnar fractures, with the roof as a separate fragment.

In the presence of preexistent hip arthritis a total hip replacement may be a better option than open reduction of the acetabular fracture.

Nonoperative treatment should be considered for undisplaced fractures, displaced fractures if a large portion of the acetabulum remains intact and the femoral head remains congruent.

Open reduction and internal fixation remains the gold-standard treatment for displaced acetabular fractures in young patients. 

Contraindications to surgery include: systemic illness or secondary multiorgan failure secondary to trauma, systemic infections or sepsis, local infection extreme osteoporosis, and severe comminuted fracture.

For displaced acetabular fractures the treatment of choice is open reduction and stable internal fixation.

Radiographs of the pelvis with both hips, and if required, inlet and outlet views of the pelvis.

Disruption of any of the normal lines of the acetabulum represents a fracture.

In most cases, the fracture can be classified from plain films alone.

Plain films are usually best for assessing the congruence between the femoral head and the roof of the acetabulum.

Roof-arc angles, are made on the AP, obturator, and iliac oblique radiographic views, or CT scans and are used to assess the size of the intact portion of acetabulum.

CT scans has improved the visualization of the fracture anatomy, the degree of comminution, and associated fracture patterns, and improves the preoperative planning of the surgical reconstruction.

Geriatric acetabular fractures are becoming increasingly common.

In the elderly: 

The three most common comorbidities are  hypertension, fluid and electrolyte disorders, and the three most common Charlson comorbidities were diabetes without complications, chronic pulmonary disease, and congestive heart failure.

28.2% of patients sustained a postoperative complication. 

The most common complications are renal (11.4%, followed by pulmonary 9.1%, thromboembolic 5.3%, and cardiac 4.1%.

Mortality rate 2.6% .

There are currently no guidelines for the treatment of acetabular fractures in elderly patients. 

Acute  complications after surgery are more dependent on injury characteristics, such as soft-tissue injury, and surgeon technique and less on patient comorbidities. 

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