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Acetabular Fracture

synonyms:

Acetabular Fracture ICD-9

  • 808.0 (closed)
  • 808.1(open)

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

  • Osteonecrosis
  • Neurologic injury
  • Infection
  • Poor wound healing
  • Chronic Osteomyelitis
  • Pain
  • Painful hardware
  • Loss of reduction
  • Nonuion
  • 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
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