Acetabular fracture

Fractures of the acetabulum are, like pelvic fractures, a result of high energy motor vehicle accidents in young or low energy falls in elderly. Fractures to joint surfaces predispose to later osteoarthritis, so proper treatment is important.

Associated ipsilateral neurovascular injury, especially of the sciatic nerve, is not uncommon and must be kept in mind. Stable fractures may be treated conservatively, while unstable fractures are treated with internal fixation or hip replacement.

Classification

Acetabular fractures may be classified according to the Judet and Letournel system or the AO/ASIF classification. Judet and Letournel classifies them according to the oblique pelvic view on x-ray. AO/ASIF classifies them according to severity and complexity.

Clinical features

Neurovascular injury in the ipsilateral extremity, especially of the sciatic nerve, may be present in up to 40% of cases, and so proper physical examination is important. Injury to the femoral artery can compromise distal blood supply as well.

Diagnosis and evaluation

Initial evaluation is usually with x-ray, but proper evaluation requires CT to look for associated injuries.

Treatment

The goal of treatment is to restore the stability of the hip joint and the congruency of the joint surfaces, to prevent later complications. Choice of treatment depends on the fracture type, stability, patient’s general condition, and age.

Stable fractures are generally treated conservatively (protected weight bearing, crutches, walker). Unstable or incongruent fractures are treated surgically with ORIF. In elderly, total hip replacement may be performed. If there is neurovascular injury, surgical treatment should be urgent.