Acetabular Fracture

Question 1

What is the acetabulum?

Answer 1

Cup-like depression in pelvis formed by ilium, ischium and pubic (tricartilage area) and articulates with head of femur.

Question 2

Structure of acetabulum

Answer 2

Anterior column extending from the anterior iliac spines to the pubic rami

Posterior column extending from sciatic notch to the ischium

Question 3

Mechanism of injury

Answer 3

High energy injury (RTC or fall from significant fall from height)

In elerdly it can be due to a low energy trauma

Question 4

Clinical features

Answer 4

Significant pain + swelling

Inability to weight bear

Associated injuries like abdominal and urethral injuries (although rare)

Question 5

Examinations

Answer 5

Neurovascular status of both limbs

Check for evidence of open fracture and assess the condition of the overlying skin for any Morel Lavallée lesions

Question 6

What are Morel Lavallée lesions?

Answer 6

Internal degloving injury.

The skin and subcut are seprated from underlying fascia due to trauma

A potential space is created that is superficial to the fascia and gets filled with fluid.

The fluid can resolve or become encapsulate and persistent.

Question 7

Ix

Answer 7

High energy injury -> Assessed and managed per ATLS guidelines

Plain film radiographs (AP view, Judet view)

In trauma setting CT scan is perfmored and is considered the gold-standard for acetabular fracture diagnosis

Question 8

What is Judet view?

Answer 8

Tilting the patient 45 degrees laterally in both directions

Question 9

Classifications of acetabular fracture

Answer 9

Judet and Letournel classification

Question 10

Explain Judet and Letournel classification

Answer 10

Divides it into two groups either elementary fractures or associated fractures.

Elementary
Posterior wall
Posterior column
Anterior wall
Anterior column
Transverse

Associated
Posterior wall + posterior column
Transverse + posterior walll
T-type
Anterior column + posterior hemitransverse
Both columns

Question 11

General management

Answer 11

ATLS guideines with resus and stabilisation

Bloods, clotting and Group&Save

Question 12

Pelvic fracture vs Acetabular

Answer 12

Major haemorrhage is not common in acetabular fractures so a pelvic binder is not indicated.

However any associated hip dislocation should be reduced urgently.

Question 13

Management of undisplaced or minimally displaced acetabular fractures

Answer 13

Conservative with protected weight bearing for 6-8 weeks

Question 14

Indications of surgical management

Answer 14

Displaced fractures and open fractures or associated with any other injury as well.

Question 15

Surgical management of young patients with displaced fractures

Answer 15

Performed to restory anatomy of joint and give pelvic stability

Question 16

Surgical management of elderly patients

Answer 16

Fracture fixation as a precursor to total hip replacement either in a single stage or two-stage procedure

Question 17

Surgical approach

Answer 17

Determined by fracture pattern.

Anterior approach usually used in anterior displacement

Posterior approach (Kocher-Langenbeck) usually used for fractures with more posterior displacement

Question 18

Complications

Answer 18

Secondary OA

VTE

Nerve injury to sciatic or obturator nerves