Principles and Management

Before we begin
ATLS life and limb threatening first Acetabular fracture may be an

indicator of significant trauma

Acetabular fractures should be

discussed with a pelvic surgeon.

Important points
1. Acetabular fractures are different to

pelvis fractures 2. Comprises of anterior & posterior walls and columns. 3. Classifications:

Letournel, 1981 Muller, 1991 Tile, 1995

Acetabular Fractures

Acetabular Fractures
There are also combined types

(complex):
Posterior wall / column Transverse / posterior wall T type Both column

Acetabular Fractures

Iliopectineal line Anterior column

Ilioischial line posterior column

Anterior & Posterior walls

Anterior & Posterior walls

Posterior Wall Fracture

Common. Motor vehicle accident Really, its a partial posterior column

fracture Associated with a dislocation and knee injuries (dashboard)

Mechanism of fracture

Posterior Wall fracture mechanism

Posterior Wall fracture radiograph

Posterior Wall fracture radiograph

Obturator Oblique: Post. wall & ant. col Iliac Oblique:

ObOb-POWAC

Ant. wall. & post. col. (cant see obturator foramen)

Posterior Wall Fracture

Kocher Langenbeck

Kocher Langenbeck
Indications: Posterior wall Posterior column Posterior wall & column Transverse T-shaped fractures PSIS GT 12cm distally. Split through Fascia Lata & Glut Max. Detatch short ext rot 1.5cm from their insertions. 75mg Aspirin for 6/52 prevents H.O.

Ilioinguinal approach
Indicated for:
Anterior wall / column fractures Transverse fractures Both column fractures

Supine. Urinary Catheter At risk:

Lateral cutaneous nerve of thigh Corona mortise (ext iliac + obt. a.

anastomosis) Femoral artery & vein.

Ilioinguinal approach
OSI radioluscent table Pillow under knees to take pressure

off femoral n. Operate through 4 windows

Very low incidence of H.O. with this approach

Heterotopic Ossification
Ectopic bone. Trabecular bone formation, outside

skeletal structures & between muscle planes. Acetabular surgery accounts for 25% Score:
Brooker Grade 1-4 on xray Alonso Grade 1-3 on CT

Tx: excision after 1 year. Prophylaxis

NSAID or Radiotherapy, or both. Bone scan checks if still active

Outcome of acetabular fractures

Controllable & non-controllable

factors If fixed, consider TTWB post-op and dont allow flexion past 90 degrees When fixing elderly hip fractures, consider ORIF + THR. Percutaneous surgery indicated if:
Polytrauma, poor skin, simple fractures

Contraindicated if fracture displaced

Summary
Trauma principles (ATLS) Advice from regional trauma centre Anterior and posterior columns Fracture classification Kocher Langenbeck and Ilioinguinal