Acetabular Fracture ICD-9
- 808.0 (closed)
Acetabular Fracture Etiology / Epidemiology / Natural History
- Generally result from high energey trauma.
Acetabular Fracture Anatomy
Acetabular Fracture Clinical Evaluation
- ATLS resuscitation. These can be high enegery injuries, assessment should begin with the A,B,C's.
- Document neurovascular exam before and after any treatment, especially reduction of dislocated hip.
Acetabular Fracture Xray / Diagnositc Tests
- A/P pelvis, and Judet views (45° iliac and oburator oblique views.)
- CT scan: assess for posterior pelvic ring injury, femoral head fracture, intra-articular fragments, impaction.
Acetabular Fracture Classification / Treatment
- Posterior Wall: posterior wall fragments <1/3 of the surface are generally stable. Fx >50% of surface are unstable. Intermiately sized fxs should undergo fluoroscopic EUA to determine stability.
- Letournel Classification
Acetabular Fracture Associated Injuries / Differential Diagnosis
Acetabular Fracture Complications
- Neurologic injury
- Poor wound healing
- Chronic Osteomyelitis
- Painful hardware
- Loss of reduction
- Limb length discrepancy
- Sitting imbalance
- Gait disturbance
- DVT / PE (Borer DS, JOT 2005;19:92).
- Heterotopic ossification: Extensile (extended iliofemoral or triradiate) approaches are associated with the highest incidence of ectopic bone formation, whereas the ilioinguinal approach is rarely associated with this complication. Rates up to 45-100% are reported. The HO is most extensive when no prophylaxis is provided using extended approaches. Routine prophylaxis consists of either 1) Indomethacin 25 mg tid for 4-6 weeks, beginning POD #1 or 2) Low dose irradiation 1000 rads in divided doses or 700 rads single dose, begun before POD #4.Surgical excision is only considered when the HO severely reduces hip mobility. Preop CT scan is recommended.
Acetabular Fracture Follow-up Care
Acetabular Fracture Review References
- Rockwood and Greens
- Epstein HC, Wiss DA, Cozen L: Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop 1985;201:9-17
- Poka A, Libby EP: Indications and techniques for external fixation of the pelvis. Clin Orthop 1996329:54-59.
- Olson SA, Pollak AN: Assessment of pelvic ring stability after injury: Indications for surgical stabilization. Clin Orthop 1996329:15-27.
- Ghanayem AJ, Stover MD, Goldstein JA, et al: Emergent treatment of pelvic fractures: Comparison of methods for stabilization. Clin Orthop 1995.318:75-8O.
- Matta JM: Fracture of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. JBJS 1996; 78A: 1632-1645