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Acetabular Fracture S32.409A 808.0

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    synonyms:

    A- initial encounter for closed fracture

    B- initial encounter for open fracture

    D- subsequent encounter for fracture with routine healing

    G- subsequent encounter for fracture with delayed healing

    K- subsequent encounter for fracture with nonunion

    S- sequela

     

    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

    • Outcome is dependent on quality of reduction.

    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