acetabulum.pptx

Acetabular fracture DR.SARKAWT S.KAKAI FKBMS(ORTHO)  Acetabulum fractures can involve one or more of the two columns, two walls or roof within the pelvis  Epidemiology  demographics  fractures occur in a bimodal distribution  high energy trauma in younger patients (e.g., motor vehicle a...

Acetabular fracture DR.SARKAWT S.KAKAI FKBMS(ORTHO)  Acetabulum fractures can involve one or more of the two columns, two walls or roof within the pelvis  Epidemiology  demographics  fractures occur in a bimodal distribution  high energy trauma in younger patients (e.g., motor vehicle accidents)  low energy trauma in elderly patients (e.g., fall from standing height) Orthopaedic manifestations Associated conditions • lower extremity injury (36%) • nerve palsy (13%) • spine injury (4%) Systemic injuries • • • • head injury (19%) chest injury (18%) abdominal injury (8%) genitourinary injury (6%) Acetabulum is supported by two columns of bone form an "inverted Y" connected to sacrum through sciatic buttress Column theory Posterior column comprisedgreater/lesser of quadrilateral surface posterior wall and dome ischial tuberosity sciatic notches Anterior column comprised of anterior ilium anterior wall and dome iliopectineal eminence lateral superior pubic ramus Imaging/Radiographs  iliopectineal line (anterior column)  ilioischial line (posterior column)  anterior wall  posterior wall  teardrop Gull sign • represents impaction of superomedial roof • seen on obturator oblique view • pathognomic for posterior wall fractures Spur sign • represents most caudal part of intact ilium due to medialization of articular components • seen on obturator oblique view • pathognomic for BC fractures indication s • now considered a gold standard in management CT Scan findings fracture pattern orientation define fragment size and orientation identify marginal impaction identify loose bodies (e.g., postreduction) • look for articular gap or step-off • • • • Elemenetry Letournel Classificatio n • • • • • Posterior wall Posterior Column Anterior wall Anterior column Transverse Associated • • • • • Both column Transverse + Posterior wall T shaped Anterior column or wall + Post. hemitransverse Posterior wall + Posterior column 1 2 3  Protected weight bearing for 6-8 weeks  Treatment Non operative  patient factors  high operative risk (e.g., elderly patients, presence of DVT)  morbid obesity  open contaminated wound  late presenting > 3 weeks fracture characteristics  minimally displaced fracture (< 2 mm)  < 20% posterior wall fractures  femoral head congruency with weight bearing roof (out of traction) skeletal traction NOT required if stable fracture pattern, outside the weight-bearing dome activity as tolerated with crutches/walker Technique weight-bearing • lowest joint reactive forces seen with toe-touch weight bearing and passive hip abduction DVT prophylaxis if slow to mobilize close radiographic follow-up