Management of Acetabular Fracture

Park, Myung Sik; Park, Hyung Ju

Abstract

Acetabular fractures are relatively uncommon, but frequency is becoming increasingly with the increase of automobile accident. Undisplaced acetabular fractures have a good prognosis, but major displaced acetabular fractures have always given rise to difficulty and have a problem if fractures are not accurately evaluated, classified and reduced anatomically. The priciples of treatment are to restore the fractured acetabulm to its normal anatomy, to maintain and restore the function and accordingly early joint motion to promote healing and to prevent joint adhesion. However, the treatment of displaced fracture of acetabulum has been controversal. Judet, Pennal and Matta advocated open reduction and internal fixation for displaced fracture of acetavbulum. But, Watson Jones and Crenshaw reported that closed reduciton such as traction was used, good result could be obtained. The authors studied the sex and age distribution, classification according to roentgenographic findings, associated injuries, methods of treatment and prognosis among 67 patients who were admitted to the department of Orthopedic Sugery of Chonbuk National University Hospital under diagnosis of acetabular fracture and we evaluate the usefulness of spring plate for posterior wall fracture of acetabulum. The results were as follows, 1. The prevalant age was fourth decade and the cause of injury was traffic accident in the majority. The most common type of fracture was posterior wall fracture and the second was transverse fracture by Letournel classification 2. The complications were posttraumatic arthritis in 21%, ectopic ossification, peroneal nerve palsy and wound infection. The prognosis of the total hip arthroplasty for complicated traumatic arthritis was relatively poor than others. 3. Satisfactory results by clinical criteria(by Postel) of operative treatment were 71% and conservative treatment 46%. In the majority of displaced acetabular fractures, open reduction and internal fixation was recommended. If surgery is attempted, it is essential to achieve an anatomical reduction and firm fixation by fully understanding the pathologic anatomy and by choosing an appropriate approach fixation device. We can make a satisfactory results by the treatment with spring plates in the comminuted posterior column fractures or posteior wall fractures that was difficulty in the treatment by simple plates.