Acetabular Fractures

Acetabular fractures are usually associated with high-energy trauma in young and active individuals, although lately the number of elderly patients with acetabular fractures has increased. A correct diagnosis of an acetabular fracture needs an adequate imaging interpretation of both radiology and tomography (CT). The anteroposterior, iliac, and obturator oblique radiological projections lead to analyze six different lines representing defined acetabular structures. The interruption of any of these lines represents a fracture and the combination will define the fracture pattern following the classification of Judet and Letournel. Additional information is obtained from the CT scan. An adequate interpretation of the injury facilitates the decision making and if the fracture needs surgical intervention, the preoperative planning. The strategies include surgical approach, reduction maneuvers, and fixation techniques. Decision on the surgical approach depends on the main fracture displacement or component. The ilio-inguinal approach is the most traditional for anterior involvement. Others, like the intra pelvic, ilio femoral, or Para rectus, are other options. For a fracture with posterior displacement, the Kocher-Langenbeck approach is the most popular. This approach can be expanded by adding a trochanteric flip osteotomy that can be used for an anterior surgical dislocation of the hip to address intra-articular reduction control or associated fracture in complex cases or delayed presentations. Extended approaches, or the association of two simultaneous approaches may be needed. Intraoperative complications can include neurovascular injury, inadequate reduction, or intra-articular hardware penetration. Deep vein thrombosis, infection, or loss of reduction can be early complications as well. Late complications represent a deterioration of the hip joint due to avascular necrosis or post-traumatic arthritis. There is a strong correlation between the accuracy of the fracture reduction and the clinical outcome.