MANAGEMENT OF ACETABULAR

FRACTURESBY

BLUE TEAM

PATHOLOGY OF ACETABULAR

FRACTUREBy Dr Kabiru Salisu

NOHD

INTRODUCTION HISTORY EPIDEMIIOLOGY AETIOLOGY PATHOPHYSIOLOGY SURGICAL

ANATOMY CLASSIFICATION

OUTLINE

INTRODUCTION

Acetabular fracture(AF), is the fracture of the socket of hip joint

is common in young adult

It is one of the most challenging fractures for the orthopaedic surgeon to understand and successfully treat

These fractures are often associated with other life-threatening injuries

Orthopaedic - Extremity

injury (36%) - Nerve palsy (13%) - Spine injury (4%)

Systemic injuries- head injury (19%) - Chest injury (18%) - Abdominal injury

(8%) - Genitourinary

injury  (6%

Acetabular fracture usually result from high energy injury

Anatomic reduction and stable fixation of the fracture, is the treatment goal in these difficult fractures

Fractures of the acetabulum were treated nonoperatively until the middle of the 20th century

The Judets & Emile Letournel study was responsible for popularizing the surgical management

History

With advances in imaging technologies, performing acetabular fracture surgery through smaller incisions is now possible

The exact incidence of acetabular fractures in various parts of the world is not known.

Studies at level I trauma centers have shown an admission rate for pelvic and acetabular fractures of 0.5-7.5%

EPIDEMIOLOGY

Acetabulum fractures usually occur as a result of high-velocity trauma, such as;

- Motor vehicular accidents or

- Falls from heights

AETIOLOGY

AF occur as a result of the force exerted through the head of the femur to the acetabulum.

The femoral head acts like a hammer and is the last link in the chain of forces transmitted from the greater trochanter, knee, or foot to the acetabulum.

The position of the femur at the time of impact and the direction of the force determine the type and displacement of the fracture

PATHOPHYSIOLOGY

◦ Inverted “Y” two column concept (1966)

◦ Columns are connected to the SI joint by a thick area of bone above the greater sciatic notch known as the sciatic buttress

Relevant anatomy

Several classifications for AF do exist, all the classifications are base on the anatomy described by Judets and letournel

CLASSIFICATION

1- Tile universal classification

This is the most widely accepted classification

This system divides fractures of the acetabulum into;

- Five simple (elementary) - Five complex (associated)

2- Letournel and Judets classification

This is a modification of judet & letournel classification

Type A- pertial articular involving only one column

A1- Posterior column fractureA2-posterior wall fractureA3- Anterior column and wall

3- AO Muller classification

Type B- Partial articular, involving transverse component

B1 - pure transverse

B2 - T- shaped

B3 - Anterior column and posterior hemitransverse

Type c- complete articular both columns C1- High variety extending to iliac crest

C2- Low variety extending to the anterior border of the ilium

C3 – Extention into the sacroiliac joint