Immediate treatment is required to prevent infection. This type of fracture is particularly serious because, once the skin is broken, infection in both the wound and the bone can occur. If the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an "open" or compound fracture. The injury to surrounding soft tissues, such as muscle, tendons, nerves, and skin.The injury to the cartilage surfaces of both the acetabulum and the head of the femur.The amount each piece is out of place (displaced) - In some cases, the broken ends of bones line up adequately in more severe fractures, there may be a large gap between the broken pieces, or the fragments may overlap each other.The number and size of the fracture fragments.The severity of the injury depends on several factors, including: If the joint remains irregular or unstable, ongoing cartilage damage to the surfaces may lead to arthritis. When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged. For example, the bone can break straight across the socket or shatter into many pieces. Outcomes of acetabular fracture fixation with ten years’ follow-up. Functional outcome of the surgical management of acute acetabular fractures. Munshi N, Abbas A, Gulamhussein MA, Mehboob G, Qureshi RA.Acetabular fractures: anatomic and clinical considerations. Lawrence DA, Menn K, Baumgaertner M, Haims AH.Mears DC, Velyvis JH, Chang CP.Displaced acetabular fractures managed operatively: indicators of outcome.4 Topics:Īcetabulum, acetabular fracture, hip fracture, orthopedics, ortho. However, due to the complex nature of these fractures, there is potential for poor outcome regardless of the injury pattern due to contributing factors such as imperfect reduction, osteochondral defects in the acetabulum or femoral head, osteoarthritis, avascular necrosis of the femoral head, sciatic nerve injury and infection. Patients with significant osteopenia or communition benefit most from total hip arthroplasty. 3 The majority of acetabular fractures are repaired by open reduction and internal fixation. 2 Fractures are organized using the Letournel Classification based on whether the fracture site lies in the anterior or posterior walls and columns of bone.Īfter diagnosis, early surgical intervention is critical in achieving good results. This is because wall fractures have an obliquely oriented fracture line on axial CT images at the roof of the acetabulum, as opposed to the coronal and sagittal fracture lines described with column and transverse fractures, respectively. Lastly, wall fractures should be evaluated with axial CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior they will show a sagittally oriented fracture line at the roof of the acetabulum on axial CT. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. First, column fractures should be evaluated with coronally oriented CT images. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall) and their corresponding radiologic views. 1Ĭlassification of acetabular fractures can be challenging. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. They occur more frequently in the elderly totaling an estimated 4,000 per year. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. Discussion:Īcetabular fractures are quite rare. The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows), with associated obturator muscle hematoma (blue oval). Her X-rays were concerning for a right acetabular fracture (see purple arrows), so the patient was referred to the emergency department where a computed tomography (CT) scan was ordered. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. She did not lose consciousness or have any other traumatic injuries. A 77-year-old female presented to her primary care physician (PCP) with right hip pain after a mechanical fall.
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