Before we begin
ATLS life and limb threatening first Acetabular fracture may be an
Important points
1. Acetabular fractures are different to
pelvis fractures 2. Comprises of anterior & posterior walls and columns. 3. Classifications:
Acetabular Fractures
Acetabular Fractures
There are also combined types
(complex):
Posterior wall / column Transverse / posterior wall T type Both column
Acetabular Fractures
Mechanism of fracture
ObOb-POWAC
Kocher Langenbeck
Indications: Posterior wall Posterior column Posterior wall & column Transverse T-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
Ilioinguinal approach
OSI radioluscent table Pillow under knees to take pressure
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
factors If fixed, consider TTWB post-op and dont allow flexion past 90 degrees When fixing elderly hip fractures, consider ORIF + THR. Percutaneous surgery indicated if:
Polytrauma, poor skin, simple fractures
Summary
Trauma principles (ATLS) Advice from regional trauma centre Anterior and posterior columns Fracture classification Kocher Langenbeck and Ilioinguinal