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An acetabular fracture is a break in the socket portion of the "ball-and-socket" hip joint.
These are fractures that occur when the head of the femur is driven into the pelvis as a result of;
There may be bruising and abrasions on the thigh or buttock
Degloving of skin in the area
Posterior column fracture is usually associated with posterior dislocation of the hip and may injure the sciatic nerve
The investigations performed include;
At least 4 x-ray views should be obtained in every case;
The management of acetabular fractures can be divided into;
Emergency management, conservative management, and operative management
Under emergency management you aim to;
Counteract shock and
Reduce a dislocation
Apply traction to the distal femur and during the next three to four days the patient's general condition is brought under control
Indications for conservative management are;
The following criteria (Matta & Merritt) should be met if conservative management is expected to succeed;
1. When traction is released, the hip should remain congruent.
2. The weight-bearing portion of the acetabular roof should be intact.
3. Associated fractures of the posterior wall should be excluded by a CT scan.
Closed reduction & Longitudinal traction, if necessary supplemented by lateral traction, is maintained for 6-8 weeks;
This will unload the articular cartilage allowing it to heal and will help prevent further displacement of the fracture.
During this period, hip movement and exercises are encouraged. The patient is then allowed up, using crutches for a further 6 weeks
In operative management, there are instances where surgery can be delayed for some days and others when its emergent
surgery can be deferred for 4-5 days in;
If stable closed reduction cannot be achieved
If the joint redislocates
Open Reduction Internal Fixation (ORIF) with lag screws or special buttressing plates which can be shaped in the operating theatre.
Post-op hip movements are started as soon as possible and the patient is allowed up, partial weight-bearing with crutches, after 7 days.
Exercises are continued for 3-6 months; it may take a year or longer for full function to return.
Deep vein thrombosis prophylaxis
The complications that may arise as a result of acetabular fractures include;