ASSOCIATED BOTH COLUMN

ACETABULAR FRACTURE

13 October 2016

Dr A. C. Mageza
MBChB(UZ); FCS Orth(ECSA)
Senior Registrar
Mr A S Makoni & Mr A C Mageza
Orthopaedics and Trauma Surgery
Parirenyatwa Group of Hospitals
dramageza@gmail.com; dramageza@icloud.com
CASE EXAMPLE 1- L M

• 31 yr old female
• 26/40 pregnant
• MVC
• Transfer from HCH
• No associated injuries
• AP rays only
ACETABULAR ANATOMY
 Letournel School

• Thorough Understanding of Plain Films

• Optimize One Surgical Approach

• Goal of Perfect Concentric Reduction

 CLASSIFICATION
ELEMENTARY
•

• posterior wall
• Posterior column
• Anterior wall
• Anterior column
• Transverse

ASSOCIATED
•

• Posterior column +posterior

wall
• Transverse + Posterior column
• Anterior column(or wall) +
Post hemitransverse
 RADIOLOGY

• Plain xray:-
•

• AP
•

• Judet views
•

• Iliac oblique
• obturator oblique
 RADIOLOGY

• Plain xray:-
•

• AP view
 RADIOLOGY

• Plain xray:-
•

• Judet views
•

• Iliac oblique
 RADIOLOGY

• Plain xray:-
•

• Judet views
•

• obturator oblique
RADIOLOGY - CT SCAN
• CT Scan
RADIOLOGY - CT SCAN
• CT Scan
DIFFERENTIAL DIAGNOSIS

• T-Type fracture

• Anterior column +

posterior hemitransverse

• Transverse with iliac

TIMING OF SURGERY

• Well - resuscitated patient

• Appropriate radiological work-up

• Understanding of fracture

• Appropriate operative team

INDICATIONS

A. Unstable hip
B. Loss of congruence
C. Displaced fractures (transtectal or juxtatectal frx
line)
D. Incongruence or diastasis of articular surface
E. Interposition of soft tissue
F. Hip displacement
Contraindications
• Physiologic instability
• Local infection

Advantages
• Early mobilization
• Anatomical reconstruction of articular surface
 
Disadvantages
• Risks of surgery
• Heterotopic bone formation (with EIF
approach)
• Nerve or vessel injury
• Infection
https://www2.aofoundation.org