PELVI-ACETABULAR FRACTURES

Chairman: Dr D R Kale
Presenter: Dr Sidharth Baheti
 Introduction
• Pelvic fractures are potentially life threatening
injuries with an increased incidence due to
high velocity RTAs.

• Survivors are at a significant risk for morbidities

like chronic pain, LLD, Sexual dysfunction etc

• 3-4 % of all fractures usually associated with

significant trauma
 Introduction
• Adult mortality 10-15%

• Mortality is ~50% if hypotensive on initial

presentation.

• Mortality is ~30% in open fractures

• Significant decrease in mortality and morbidity

if prompt stabilization of an unstable #
ANATOMY
The bony pelvis lies in close proximity to various vascular
neural and soft tissue structures making these structures
vulnerable in the event of pelvic ring disruptions
 Historical perspective
• These #s were historically managed conservatively
and many authors reported poor results.
• Holdsworth (1948) in first described that pts with
pure SI dislocations fared worse than
Illium/sacrum#.
• Slattis reported mortality as high as 17%
• Several publications popularized use of external
fixators.
• But later it became clear that Ex-Fix may be
adequate for anterior/lateral injuries but not for
posterior injuries.
 Clinical Evaluation
SUSPECT
Start with ABCDs
Evaluate for other injuries to head, chest,
abdomen and spine
INSPECTION
• Skin around the perineum
• Bleeding PV/PR/PU
• LLD and abnormal extremity rotation
• Neuro-vascular status
Associated signs:
- Roux's sign:
- a decrease in the distance from the
greater trochanter to the pubic crest on the
affected side in lateral compression frx;

- Earle's sign:
- a bony prominence or large hematoma
as well as tenderness on rectal examination;
 Moral Lavale Lesion

Destot Sign
Palpation
• Post---Haematoma/defect---SIJ or post #
• ASIS: Pushed towards- IR stability, Apart- ER
stabiity
• Lower extremity pushed for vertical stability
 Imaging Pelvic Fractures
• Plain Radiographs- AP view
 Imaging Pelvic Fractures
• Plain Radiographs- AP view

Pubic Rami #
Symphyseal Displacement
SIJ and Sacrum
Illiac #
L5 transverse process
Asso acet/proximal femur
2. Plain Radiographs- Inlet view
Anterior/posterior Displacement
of Sacrum, SIJ, Illium, symphysis
Rotational deformities of illium
Impacted sacral fractures
3. Plain Radiography Outlet view

Adequate image when pubic

symphysis overlies S2 body
Imaging

CT scan
Gold standard for pelvic fractures. Detailed
information about anterior and posterior ring

MRI
Limited role.
GU and Vascular structures
CLASSIFICATION of pelvic fractures
Young and Burgess Classification
Most common classification used
Based on the mechanism of injury
Tile/AO Classification
Tile/AO Classification
Type A: STABLE
 Tile/AO Classification
Type B: Rotationally unstable, Vertically
stable
 Tile/AO Classification
Type C: Rotation and vertically
unstable
Sacral Fracture-Denis Classification
 Miscellaneous Fractures

MALGAIGNE’s # STRADDLE #
 Principles of Initial Management
• Suspect if high velocity RTA(car vs pedestrian;
Motorcycle) or a fall from height(usually
>15feet)
• Pelvis has no inherent stability and relies on
ligamentous supports.
• Vascular structures are intimately associated
with ligaments and are often injured.
German registry
reported a drop
in mortality from
11% to 6% after a
protocol was
established.
 Circumferential Pelvic wrapping
• First patient; teague 1993,CA
• CORR 1995
• ATLS provider manual in 1997
• Can be done with a bedsheet or a Pelvic
binder.
• Where to wrap??
At the level of the Greater Trochanters

• How much force????

150-170N
 Pneumatic Anti-shock Garment
• Inflatable device traditionally used by the
armed forces.
• Great value in transport and initial
stabilization of patient; acts as a air splint
Disadvantages of PASG

• Risk of displacement in LC injuries

• Restricts access to patient
• Increased risk of compartment syndrome
 External Fixation
• Indications
– pelvic ring injuries with an external rotation
component (APC, VS, CM)
– unstable ring injury with ongoing blood loss

• Contraindications
– ilium fracture that precludes safe application
– acetabular fracture
 Technique
– theoretically works by decreasing pelvic volume
– stability of bleeding bone surfaces and venous
plexus in order to form clot
– pins inserted into ilium
• single pin in column of supracetabular bone from AIIS
towards PSIS
– obturator outlet or "teepee" view to visualize this column of
bone
– AIIS pins can place the lateral femoral cutaneous nerve at risk
• multiple half pins in the superior iliac crest
– place in thickest portion of anterior ilium, gluteus medius
tubercle or gluteal pillar
– should be placed before emergent laparotomy
 Angiography / Embolization
• Indications
– controversial and based on multiple variables
including:
– protocol of institution, stability of patient,
proximity of angiography suite , availability and
experience of staff
– CT angiography useful for determining presence or
absence of ongoing arterial hemorrhage (98-100%
negative predictive value)
 Non-Operative Management
• Lateral impaction type injuries with minimal
(< 1.5 cm) displacement
• Pubic rami fractures with no posterior
displacement
• Minimal gapping of pubic symphysis
– Without associated SI injury
– 2.5 cm or less, assuming no motion with stress or
mobilization
– This number is not absolute, so other evidence of
instability (like SI injury) must be ruled out
 Non-Operative Management
• X-rays are static picture of dynamic situation
– It may be that the deformity is worse than seen on
X-rays taken
– Stress radiographs may be helpful
– Other evidence of instability should be sought
• Lumbar transverse process fractures
• Avulsions of sacrotuberous/sacrospinous ligaments
 Non-Operative Treatment
• Tile A (stable) injuries can generally bear
weight as tolerated
• Walker/crutches/cane often helpful in early
mobilization
• Serial radiographs followed during healing
• Displacement requires reassessment of
stability and consideration given to operative
treatment
 Non-Operative Treatment
• Tile B (partially stable) injuries can be treated
non-operatively if deformity is minimal
• Weight bearing should be restricted (toe-
touch only) on side of posterior ring injury
• Serial radiographs followed during healing
• Displacement requires reassessment of
stability and consideration given to operative
treatment
 Principles of Operative Treatment
• Posterior ring structure is important

• Goal is restoration of anatomy and enough

stability to maintain reduction during healing

• Most injuries involve multiple sites of injury

– In general, more points of fixation lead to greater
stability
– This does NOT mean that all sites of injury need
fixation
 Principles of Operative Treatment
• Anterior ring fixation may provide structural
protection of posterior fixation

• If combined open and percutaneus techniques

are used, the open portion is often done first to
aid in reduction of the percutaneusly treated
injury

• LETOURNEL’s Golden rule: Posterior stabilization

to be done before anterior as posterior is the
main weight bearing part.
 Anterior Pelvic Ring Injuries
Indications for ORIF
• Symphyseal dislocation >2.5cm(static or
dynamic)
• To augment posterior fixation in vertically
dislaced fractures.
• Locked symphysis.
 Surgical Approach to the
Anterior Pelvic Ring
Pfannenstiel Approach
•Supine Position
•8 cm incision
•A Foley catheter and
nasogastric tube are inserted
•The cut edges of the
rectus abdominal
muscles superiorly to
reveal the symphysis
and pubic crest.

• If access to the back of

the symphysis is
required, use the
fingers to push the
bladder gently off the
back of the bone
 Symphyseal Dislocations
• Ant Ex Fix = Internal Fixation for controlling
rotation but Internal fixation >>> for resisting
vertical displacements

• Ex fix particularly useful in open injuries or pts

requiring GI/GU procedures.
 ORIF of Symphyseal disruptions
• Apply circumferential wrap at the level of the
GT.
• Internally rotate the legs and tape them.
• Ant approach to pubic symphysis.
• Place reduction forceps anteriorly so that
plate can be put on the superior surface.
• Inlet view: judge the alignment of the plate;
• Outlet view judge the length of screws;screws
should have a bicortical purchase.
 Fractures of the Pubic ramus
• Fractures medial to insertion of inguinal
ligament should be treated like symphyseal
dislocations.

• Comminuted fractures: ORIF

• Minimal comminution: Ramus screw(ante vs

retro)
 Fractures of the Pubic ramus
• Reduction technique
Secure a precontoured plate in the supra-
acetabular bone.
One tine of the reduction forceps on the medial
fragment and another on the most medial hole
of the plate.
 Posterior Pelvic Ring Injuries
• Indications for ORIF:-
1. Displaced illiac wing fractures that enter and exit
both the crest and GSN/SIJ.
2. Multiplanar instability(disruption of ligaments)
3. Non impacted comminuted displaced sacral
fractures.
4. Vertical or cephalad displacement.
5. U shaped fractures with spino-pelvic
dissociation
 Approaches to posterior pelvic ring
Posterior approach to SIJ
• Pt is placed prone with logitunal traction.
• In severely displaced fractures we can rigidly fix the
contralateral pelvis
Approaches to posterior pelvic ring
Posterior approach to SIJ
Anterior Approach to the Sacroiliac Joint

• Make a curved incision over

the iliac crest, beginning 7 cm
posterior to the anterior
superior iliac spine. Curve the
incision anteriorly and
medially along the line of the
inguinal ligament for 5 cm.
• Subperiosteally dissect the illiacus muscle and
retract medially to reach the anterior part of
the SIJ.
• Care should be taken not to injure L5 nerve
root.
Posterior approach to Sacrum
 Sacroilliac Joint Dislocations
• Posterior approach----Only inferior joint
visualised
• Anterior approach----Superior Ala visualized
• Longitunal traction is the single most
important maneuvre.
• Important to let the pelvis hang free as
pressure on ASIS will lead to ext rotation
• Two reduction forceps
 Illio-Sacral screw Placement
• Inlet projection—screw
towards anterior aspect
of promontory
• Outlet ---screw is above
the S1 foramen
• Screw to be directed
anteriorly; superiorly
and medially. Lateral Projection
Be aware of sacral dysmorphism
 Illiac wing fractures and fracture
dislocations( Crescent fractures)
• Illiac wing fractures exiting through the SIJ are crescent #.
• Crescent fragment is the variable sized that contains the
PSIS and PIIS and remains attached to the sacrum.
• Smaller the “CRESCENT” fragment > damage to posterior
structures
 Crescent fractures
• Always approched posteriorly
 SACRAL Fractures
• Can be regarded as a pelvic injury, spinal injury
or both.
Indications for fixation:-
Ant and post ring disruption with vertical sheer
sacrum fracture.
Comminuted # with rotation
Spinal-pelvic dissociation
Rarely in impacted # with Internal rotation
deformity
Illiosacral screw

Plate fixation
 Spinal-Pelvic fixation

1. Spinal point of fixation- L5(usually)

2. Illiac screw just inf to PSIS
3. Illiac screw is connected to pedicle screw with appropriate
rods and screw-rod clamps

This bypasses the lines of force transmission from spine to illium

through the construct instead of the sacrum
 Post-Operative Care
• Mobized to chair 1st day post-op
• Toe touch weight bearing upto 10 weeks
(unstable injuries)
• Stable injuries immediate post-op FWB.
• DVT prophylaxis.
• Prophylaxis for hetereropic ossification.
 Complictaions
• Intra-operative haemorrhage
• Inability to achieve reduction
• Wound infection.
• Newly recognized post-op neurologic deficits
• Loss of fixation and reduction
• Sexual dysfunction
ACETABULAR FRACTURES
 Introduction
• Generally caused by high energy trauma

• Such high energy injuries usually have a high

incidence of major associated injuries

• The fracture or fracture dislocation produced

depends on the magnitude and the direction of
the injuring force as well as on the strength of
the bone.
 Pathoanatomy
• Fractures depend Position of
Fracture location
on the position of femoral head
the femoral head
at the moment of Posterior column # IR
impact
Anterior column # ER

Superior dome # Adduction

Inferior aspect of the

Abduction
dome #
 Acetabulum - Anatomy
• Incomplete hemispherical
socket with an
– inverted horse-shoe shaped
articular surface
– non articulating cotyloid
fossa.
• The articular surface is
composed of and supported
by two columns of bone
(described by Letournel and
Judet) as an inverted ‘Y’
 Acetabulum – Anatomy
‘The Column Concept’
• Used in the classification of the fractures
• The anterior column
– Iliac crest, iliac spines, the anterior half of the acetabulum
and the pubis.
• The posterior column
– Ischium, ischial spine, posterior half of the acetabulum and
the dense bone forming the sciatic notch
• The shorter posterior column ends at its intersection
with the anterior column at the top of the sciatic
notch
 Acetabulum - Anatomy
• The dome or roof is the weight bearing
portion of the articular surface that supports
the femoral head
• The quadrilateral surface is the flat plate of
bone forming the lateral border of the pelvic
cavity
• The iliopectineal eminence is the prominence
in the anterior column that lies directly over
the femoral head.
 Acetabulum – Anatomy
Neurovascular structures
• The sciatic nerve
• The superior gluteal Artery and Nerve
• Corona mortis
 Classification
(Letournel and Judet)
• Simple fractures
– fractures of the posterior wall, posterior column,
anterior wall, anterior column and transverse
fractures.
• Associated fractures
– T-shaped fractures, fractures of the posterior
column and posterior wall, transverse + posterior
wall fracture, anterior fracture + hemitransverse
posterior fracture and both column fracture.
 Signs and symptoms
• Apart from local examination
– Look out for associated life threatening injuries
(intra-abdominal injuries)
– A, B, C first before the rest
– Older patients
• Arrhythmia, transient ischemic attacks  may have led to the fall
– SDH can occur when older patients fall.
 Radiographic Evaluation
• Requires
– A CT scan
– 3 plain radiographic views
• Antero-posterior view of the hip
• 45° iliac oblique view
• 45° obturator oblique view

Judet view  45° oblique view

 Plain Radiographs
1 - AP View
• Start evaluation with this view
• Iliopectineal line – represents the anterior column;
Ilioischial line – represents the posterior column; Posterior
lip – represents the posterior wall; Anterior lip – represents
the anterior wall; Dome; Tear-drop
 Plain Radiographs
2 - The obturator oblique view

• Anterior column
fracture displacements
• Posterior wall
fragments and their
displacement
 Plain Radiographs
3 - The iliac oblique view
• Posterior column #
• Anterior wall #
 CT Scan
• 3 mm interval axial cuts
• Include the entire pelvis to
avoid missing a portion of
the fracture
• Compare with opposite hip

 Watch for
Anterior and posterior wall fragments, marginal
impaction, retained bone fragments in the joint,
comminution, presence or absence of a dislocations
and any sacroiliac joint pathology.
 Management
• Initial treatment – follow ATLS protocols
• Operative treatment of acetabular fractures
are usually not performed as an emergency
• Normally, a closed reduction  Skeletal
traction
 Operative Surgical anatomy
• Posterior wall fragments
– vary in the size and degree of comminution
– Well appreciated in a CT scan.
– Unrecognized fracture lines maybe detected at
surgery
– So the posterior wall fracture should never be
fixed with lag screw alone.
– The posterior wall fragment receives its blood
supply from the capsule  avoid detaching the
capsule from its blood supply.
 Operative Surgical anatomy
• Posterior Column fractures
– Can occur anywhere along the posterior column
from the ischial spine to the sciatic notch.
– Typically, the column fragment rotates.
– It is necessary to derotate the fragment and check
the reduction.
 Operative Surgical anatomy
• Anterior Column fractures
– Occur at various levels along the anterior column.
– Although the pubic ramus is part of the anterior
column, ramus fracture usually indicates the
presence of a pelvic fracture rather than an
acetabular fracture.
 Operative Surgical anatomy
• Transverse fractures
– Run across the acetabulum.
– transtectal: fracture courses through the weight-bearing
dome (WBD);
– juxtatectal: fracture courses above the cotyloid fossa, so
that a significant portion of the wt bearing dome is left
intact;
– infratectal: fracture courses below the wt bearing dome.
• T-type fractures
– Transverse fracture with a fracture line seperating the
anterior column from the posterior column
 Operative Surgical anatomy
• Anterior and posterior hemi-transverse
fractures
– This is an anterior column fracture with and
additional fracture line that runs transversely
across the posterior column.
– Here, the displacement is usually anterior and the
posterior column not significantly disturbed.
– Thus reducing the anterior column usually reduces
the posterior column.
 Operative Surgical anatomy
• Both column fractures
– Entire acetabulum is separated from the axial skeleton.
– Sometimes, it is called as a floating acetabulum.
– Since the entire acetabulum is separated from the ilium,
the actual joint can appear congruent.
– This radiographic appearance is called the secondary
congruence.
– Spur sign
 Spur sign
• Pathognomonic of both
column fratures. see in
obturator oblique view
 Surgical Approaches
• Iliofemoral
• Ilioinguinal
• Kocher Langenbeck
• Triradiate transtrochanteric
• Extended iliofemoral
• Combined anterior and posterior approach
Kocher – Langenbeck approach
• The Kocher-Langenbeck
approach is a
nonextensile approach to
the posterior acetabular
column
Outline all bony landmarks
with a sterile marking pen:
(1) posterior superior iliac
spine
(2) greater trochanter
(3) shaft of femur

incise the subcutaneous

tissues along
the gluteus maximus muscle
(using scissors)
the tractus iliotibialis (using a
scalpel)
Isolate the piriformis tendon
and the conjoined tendons
of the obturator internus and
superior and inferior gemelli
muscles.

They are tagged and incised

1 cm lateral from their
femoral insertions.
Illio-Inguinal Approach
The ilioinguinal
approach was
developed by Emile
Letournel based on
cadaveric dissections
to provide anterior
access for fractures
of the acetabulum.
Illio-Inguinal Approach
Make a curved incision beginning
posterior to the ASIS and extend
past the midline 2 cm proximal to
the symphysis.

the external oblique aponeurosis

is incised from the ASIS to the
lateral border of the rectus
sheath, passing cranial to the
external inguinal ring.
Illio-Inguinal Approach
Mobilize the spermatic cord or round
ligament in a sling. The posterior wall
of the inguinal canal is now exposed

Divide the rectus abdominal muscle 1 cm

proximal to its insertion into the symphysis
pubis. Divide the muscles forming the
posterior wall of the inguinal canal

Ligate and divide the inferior epigastric

vessels.
Illio-Inguinal Approach

Using a swab, push the peritoneum upwards to

reveal the femoral vessels. Mobilize the iliacus
muscle from the inner aspect of the ilium.

Isolate the femoral vessels together in the

femoral sheath and protect them with a rubber
sling. Pass a second sling around the tendon of
iliopsoas with the femoral nerve lying on top of it
• The first window encompasses the entire internal
iliac fossa from the sacroiliac joint posteriorly to
the iliopectineal eminence anteriorly.

• The second window provides access to the pelvic

brim and quadrilateral surface from the sacroiliac
joint to the lateral third of the superior pubic
ramus.

• Through the third window the entire medial

portion of the superior ramus and symphysis can
be visualized
 Extended Iliofemoral approach
• It gives excellent visualization of the ilium, the superior
dome and the posterior column. The anterior column can
be seen up to the iliopectineal eminence. This exposure is
similar to that provided by the triradiate approach with the
additional benefit of access to the bone above the sciatic
notch.
 Triradiate transtrochanteric
approach
• It is ideal for fractures with both column injuries where in the
entire outer table of the pelvis from the anterior superior iliac
spine to the top of the sciatic notch can be seen.
 Combined anterior and posterior
approaches

• Patient is in lateral position with no fixed support. It allows

for the surgeon to roll the patient prone or supine if
necessary.
Approaches for specific fractures
Approaches for specific fractures
 Indications for non-operative treatment

• Non displaced and minimally displaced

fratures.

• Fractures that traverse the wt bearing dome,

but with less than 2 mm displacement –
managed by non wt bearing and or skeletal
traction for 8 weeks.
 Indications for non-operative treatment
• Fractures with significant displacement but, in which the
region of the joint involved is judged to be unimportant
prognostically.

• This can be determined by the roof arc measurement

described by Matta and Olson as 45 degrees for each roof arc,
medial, anterior and posterior.

• Most authors agree that displaced fractures through the

weight bearing dome should be treated with ORIF, regardless
of how they ‘line up’ in traction.
Roof arc measurement
 Medical contraindications to surgery
• Multisystem injury
• An open wound in the anticipated surgical
field  The Morel – Lavallée lesion
• Presence of a suprapubic catheter is a
contraindication for ilioinguinal approach.
• Elderly patients with osteoporotic bone –
where ORIF may not be feasible.
 Indications for operative treatment
• In fracture incongruity due to
– Posterior column or wall injuries
– Displaced fractures of the superior dome
– Retained bony fragments
• In the limb
– Sciatic nerve injury
– Fracture of the ipsilateral femur
– Injury to the ipsilateral knee
• In the patient – polytraumatised patient
Treatment of specific fracture patterns
• Posterior wall fractures
– Posterior Langenbeck approach with the patient
positioned either prone or lateral using lag screw and a
reconstruction plate placed from the ischium over the
retro acetabular surface onto the lateral ileum. (If the
fracture extends superiorly into the dome, a trochanteric
osteotomy may be performed to allow additional
exposure)
– To avoid AVN of the posterior wall, the posterior wall
fragments must not be detached from the posterior
capsule. The knee must be kept flexed throughout the
procedure to avoid injury to the sciatic nerve.
Treatment of specific fracture patterns
• Posterior column fracture
– Though uncommon if significantly displaced, requires ORIF
(Kocher Langenbeck approach).
– Typical fixation is with a lag screw combined with a
contoured reconstruction plate along the posterior
column.
– Rotational deformity must be corrected by placing a Shanz
screw in the ischium to control rotation while the fracture
is reduced with a reduction clamp
Treatment of specific fracture patterns
• Anterior wall and anterior column fracture
– Isolated anterior wall fractures are uncommon.
– Sometimes, they are associated with anterior hip
dislocation.
– Fractures requiring surgery are fixed with a buttress plate
applied through an ilioinguinal or iliofemoral approach.
– Anterior column fractures are approach similarly with
fixation by a contoured plate along with a pelvic brim.
Treatment of specific fracture patterns
• Transverse fractures
– Transtectal fractures have the worst prognosis and
accurate reduction is essential.
– Juxtatectal fractures also usually require reduction.
– Typical reduction is through a posterior approach using a
Farabeuf clamp to reduce the fractures while rotation is
controlled by a Shanz screw in the ischium.
– Posterior fixation typically is with a buttress plate along the
posterior column and anterior fixation using a lag screw
placed into the anterior column from a position above the
acetabulum.
Treatment of specific fracture patterns
• Posterior Column fracture with associated posterior
wall fracture
– A Kocher-Langenbeck approach is used with or with out a
trochanteric osteotomy.
– The column fracture is reduced first.
– A short reconstruction plate is placed posteriorly along the
posterior edge of the column. A separate plate is used for
the wall fragment.
– T screws through the plate secure rotational reduction on
the posterior column fragment.
Treatment of specific fracture patterns
• Transverse fracture with associated posterior
wall fracture
– The common fracture can be difficult to reduce.
– The posterior wall component requires a posterior
exposure, but reduction of the anterior part of the
transverse fracture can be difficult through a
Kocher-Langenbeck approach and extensile or
combined approach is frequently necessary.
Treatment of specific fracture patterns
• T-type and anterior column-posterior Hemi-
transverse fracture
– They are treated through an ilioinguinal approach with a
contoured plate placed along the pelvic brim and lag
screws extending into the posterior column.
– For a T-type fracture with severe posterior displacement
but minimal anterior displacement, posterior approach
alone may be sufficient with placement of anterior column
lag screw.
– If both the anterior and posterior components of the
fracture are significantly displaced, an extensive or
combined approach are required.
Treatment of specific fracture patterns
• Both column fractures
– These have varying degrees of comminution and can be
extremely complex and difficult to treat.
– Many both column fractures can be treated through an
anterior ilioinguinal approach.
– But a posterior or extensile exposure is required for
involvement of the sacroiliac joint, significant posterior
wall fracture, or intraarticular comminution.
– Reduction is begun from the most proximal portion of the
fracture and proceed towards the joint.
Implants for acetabular fractures
 Post-operative care
• Closed suction drain
• Antibiotic for 48 – 72 hours
• Passive motion of the hip on the 2nd or 3rd day.
• Touch down ambulation & crutches on 2nd to 4th
day.
• The minimal weight bearing status is continued for 8
weeks in patients with simple fractures and 12 weeks
in most others.
• Rehabilitation of the abductor muscle group is
needed.
 Complications
• General
– Thromboembolic disease
– Infection
• Specific
 Specific Complications
• Sciatic nerve injury
– Thirty percentage of acetabular fractures have associated
sciatic nerve injury.
– In 2 – 6 % of patients, it occurs as a result of surgery and is
more often associated with posterior fracture pattern
treated through a Kocher-Langenbeck and extensile
exposures.
– The peroneal component of sciatic nerve is more often
involved than the tibial component.
– Complete peroneal palsies have the worst prognosis. Tibial
component has greater chances of recovery.
 Specific Complications
• Other nerves
– Femoral nerve injury – though rare, care to be taken
during the anterior ilioinguinal approach.
– Superior Gluteal nerve injury is vulnerable in the greater
sciatic notch, resulting in abductor paralysis.
– Pudendal nerve injury
– Injury to the lateral femoral cutaneous nerve causes
sensory loss in the lateral aspect of the thigh.
 Specific Complications
• Post-traumatic arthritis
• Heterotopic ossification
• Chondrolysis
• AVN
Thank You