Complex Fractures of the Acetabulum

Abstract

Acetabular fractures constitute 18 % of pelvic injuries and most often occur in young adults involved in high-energy motor vehicle collisions or falls from a height. The treatment of acetabular fractures is a complex area of orthopaedics that is continually refined. Patients with acetabular fractures often have multiple injuries, and the initial approach to evaluation should follow ATLS guidelines. CT scan is currently the best diagnosis tool in the acetabular fracture assessment. There are several acetabular fracture classification schemes. However, the most widely used is the Judet-Letournel classification scheme. Nondisplaced fractures or displaced fractures that do not involve the dome of the acetabulum are treated nonsurgically, except posterior wall fractures. Open reduction and internal fixation, as for any other intra-articular fracture, is now a standard treatment for a displaced acetabular fracture. The approach selected depends on pattern and location of the fracture: ilioinguinal or modified Stoppa for anterior fractures and Kocher-Langenbeck for posterior fractures. Both-column fractures may require both an anterior and a posterior approach. Early complications include deep vein thrombosis, post-traumatic nerve palsies (16.4 %), and wound infection (4–5 %). Late complications are as follows: heterotopic ossification (25.6 %), osteoarthritis (26 %), and avascular necrosis (3–53 %). 8.5 % of the patients require total hip arthroplasty 2 years following the initial procedure. The treatment of these fractures sets high demands and needs to be in the hands of experts. In these cases, an excellent or good functional outcome can be expected in between 83 and 89 % of patients with an anatomical reduction.