• Treatment of acetabular fractures is a complex area
of orthopaedics that is being continually refined.
• Caused by high energy trauma and associated
injuries are frequent.
• Management of entire patient should follow
accepted ATLS protocol.
• Acetabulum; Incomplete hemispherical socket with
an inverted horseshoe shaped articular surface
surrounding the nonarticular cotyloid fossa.
• Articular socket supported by two columns of bone,
described by Letournel and Judet as an inverted Y.
• Matta et al developed a system for roughly
quantifying the acetabular dome after fracture, which
they called the ‘Roof arc” measurement.
• Determines if the remaining intact acetabulum is sufficient to
maintain a stable and congruous relationship with femoral head.
• If any of the roof arc measurements in a displaced fracture are
less than 45 degrees, operative treatment should be considered
• CT scan is invaluable in the treatment of acetabular
• Radiographs allow proper fracture classification
• Fracture location and displacement determine need
• Fracture Pattern determines Approach.
Non Operative ; Indications
• Nondisplaced and minimally displaced fractures (<2 mm)
• Fractures with significant displacement but in which the region of the joint
involved is judged to be unimportant prognostically (roof arc).
• Secondary congruence in displaced both column fractures
• Medical contraindications to surgery
• Local soft tissue problems, such as infection, wounds and soft tissue lesions
• Elderly patients with osteoporotic bone in whom open reduction may not be
Non Operative Treatment Techniques;
• Bed Rest with joint mobilisation.
• When there is adequate fracture healing , usually by
6-12 weeks , gradually progress to full weight
• Prolonged traction treatment for those patients with
operative indications related to fracture displacement
but having contraindications to surgical intervention.
Indications for operative treatment
• With 2 mm or more of displacement in the dome of acetabulum as
defined by any roof arc measurements of less than 45 degrees
• any subluxation of the femoral head from a displaced acetabular
fracture noted on any of the three standard radiographic views
• Posterior wall fractures with more than 50% involvement of the
articular surface of the posterior wall.
• Incarcerated fragments in the acetabulum after closed reduction of
• Urgent surgical interventions
-Irreducible hip dislocation
-Worsening neurologic deficit
• No delay beyond 15 days for elementary fractures and 10 days
for associated types
Selection of Surgical approach
• Fracture type
• Elapsed time from injury to operative intervention
• Magnitude and location of maximal fracture
Fracture Reduction & Fixation;
• First reduce and stabilise the
displaced columns , if present and
then reduce any wall fracture.
• After definitive fixation of the
reduced fragments, the entire
construct is stabilised with
• Mini open exposure through lateral window of ilioinguinal
• To prevent potential further fracture displacement.
• Displaced fractures in elderly.
• Simple fractures with minimal displacement
• As an adjunct to standard ORIF techniques
• Severe injuries that prevent formal ORIF
• Use of Stoppa Approach with the Lateral window of
the ilioinguinal approach has been promoted as a
way of avoiding the dissection of the middle window
of the ilioinguinal approach and thus exposure of
femoral vessels and nerve.
• Overall mortality rates (0 - 2.5%)
• Post traumatic arthritis & osteonecrosis of femoral head
• Sciatic nerve palsy (10-15% ;2-6%)
• Heterotopic ossification
• Thromboembolic complications
• Intra articular hardware
• In older patients with extremely poor prognoses.
• Indications include intraarticular comminution,
full thickness abrasive loss of articular cartilage,
impaction of femoral head, impaction of dome,
associated femoral neck fracture and
• Fractures can be fixed with percutaneous
screws, plates or cables and fixation augmented
with multiple screw fixation of the ingrowth cup.