acetabulum
DESCRIPTION
Powerpoint presentation on Orthopaedic Trauma Surgery and the AcetabulumTRANSCRIPT
Principles and Management
Before we begin
ATLS – life and limb threatening first
Acetabular fracture may be an indicator of significant trauma
Acetabular fractures should be discussed with a pelvic surgeon.
Important points
1. Acetabular fractures are different to pelvis fractures
2. Comprises of anterior & posterior walls and columns.
3. Classifications: Letournel, 1981 Muller, 1991 Tile, 1995
Acetabular Fractures
Acetabular Fractures
There are also combined types (complex):
Posterior wall / column Transverse / posterior wall T type Both column
Acetabular Fractures
Iliopectineal line – Anterior column
Ilioischial line – posterior column
Anterior & Posterior walls
Anterior & Posterior walls
Posterior Wall Fracture
Common. Motor vehicle accident Really, it’s a partial posterior column
fracture Associated with a dislocation and
knee injuries (dashboard)
Mechanism of fracture
Posterior Wall fracture mechanism
Posterior Wall fracture radiograph
Posterior Wall fracture radiograph
Obturator Oblique: Post. wall & ant. col ObOb-POWAC
Iliac Oblique: Ant. wall. & post. col. (can’t see obturator foramen)
Posterior Wall Fracture
Kocher Langenbeck
Kocher Langenbeck
Indications:Posterior wallPosterior columnPosterior wall & columnTransverseT-shaped fractures
PSIS – GT – 12cm distally.Split through Fascia Lata & Glut Max.Detatch short ext rot 1.5cm from their insertions.75mg Aspirin for 6/52 prevents H.O.
Ilioinguinal approach
Indicated for: Anterior wall / column fractures Transverse fractures Both column fractures
Supine. Urinary Catheter At risk:
Lateral cutaneous nerve of thigh Corona mortise (ext iliac + obt. a.
anastomosis) Femoral artery & vein.
Ilioinguinal approach
OSI radioluscent table Pillow under knees to take pressure
off femoral n. Operate through 4 windows
Very low incidence of H.O. with this approach
Heterotopic Ossification Ectopic bone. Trabecular bone formation, outside
skeletal structures & between muscle planes.
Acetabular surgery accounts for 25% Score:
Brooker Grade 1-4 on xray Alonso Grade 1-3 on CT
Tx: excision after 1 year. Prophylaxis NSAID or Radiotherapy, or both.
Bone scan checks if still active
Outcome of acetabular fractures Controllable & non-controllable
factors If fixed, consider TTWB post-op and
don’t allow flexion past 90 degrees When fixing elderly hip fractures,
consider ORIF + THR. Percutaneous surgery indicated if:
Polytrauma, poor skin, simple fractures Contraindicated if fracture displaced
Summary
Trauma principles (ATLS) Advice from regional trauma centre Anterior and posterior columns Fracture classification Kocher Langenbeck and Ilioinguinal