eMedicine Specialties > Orthopedic Surgery > Hip

Acetabulum Fractures: Follow-up

Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho, Assistant Professor of Orthopedic Surgery and Pediatrics, Thomas Jefferson University; Consulting Staff, Department of Pediatric Orthopedic Surgery, Alfred I duPont Hospital for Children; Orthopedic Oncologist, Helen F Graham Cancer Center and Christiana Care Health Services
Coauthor(s): Nirmal Tejwani, MD, MPA, Associate Professor of Orthopedic Surgery, New York University Hospital for Joint Diseases; Chief of Orthopedic Trauma, Bellevue Hospital; Chandrashekhar Thakkar, MBBS, Professor of Orthopedics, Lokmanya tilak Municipal Medical College, University of Mumbai, India
Contributor Information and Disclosures

Updated: Jul 8, 2009

Outcome and Prognosis

Factors in the injury pattern affecting prognosis include the following:

  • Force of energy - High- versus low-energy trauma
  • Location - Instability allowed with superior roof, posterior wall, and column fractures
  • Degree of articular comminution of both the acetabulum and the femoral head
  • Degree of initial displacement
  • Associated injuries

Treatment factors affecting the prognosis are the quality of the reduction, which ideally restores congruity, and the quality of fixation, which ideally restores stability.

The prognosis can also be affected by complications such as the following:

  • Avascular necrosis
  • Metal in the joint
  • Chondrolysis
  • Sepsis
  • Heterotopic ossification
  • Neurovascular injury

Studies have confirmed the positive association between the accuracy of reduction and a better long-term result.8,60 However, many series have shown that, even when these goals are achieved, posttraumatic arthritis still occurs in up to 30% of patients.6,8,61,62,63 Contributing factors may include an imperfect reduction, osteochondral defects in either the acetabulum or the femoral head, chondrolysis due to articular trauma at the time of injury, and AVN of the femoral head or the acetabulum. Once symptomatic posttraumatic arthritis has developed, options for salvage generally are limited to total hip arthroplasty and arthrodesis.

Future and Controversies

Technique development

As techniques continue to develop and improve, imaging is being used more and more in the treatment of acetabular fractures. Brown et al have reported the use of computer-generated 3-D CT moving images for preoperative planning and screw/pin insertion and use of stereolithography (wax or plastic 3-D model of bony anatomy) to develop a computer-generated "clip on" interpositioning template for accurate placement of plate and screws. These new technologies provide the surgeon with precise information about the fracture patterns and allow effective preoperative planning and accurate fixation of acetabular fractures.64  Citak et al have reported on virtual 3-D planning of acetabular fracture reduction.65

Prophylaxis controversies

The best modality of preoperative DVT prophylaxis remains controversial; multiple options are available, but the current trend is to use sequential compression devices for prophylaxis in the preoperative period.

Similarly, the best form of prophylaxis against heterotopic ossification remains controversial; however, indomethacin appears to be used most frequently at present.

 


More on Acetabulum Fractures

Overview: Acetabulum Fractures
Workup: Acetabulum Fractures
Treatment: Acetabulum Fractures
Follow-up: Acetabulum Fractures
Multimedia: Acetabulum Fractures
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Dean DB, Moed BR. Late salvage of failed open reduction and internal fixation of posterior wall fractures of the acetabulum. J Orthop Trauma. Mar 2009;23(3):180-5. [Medline].

  2. Mehin R, Jones B, Zhu Q, Broekhuyse H. A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg. Jun 2009;52(3):221-8. [Medline].

  3. Boraiah S, Ragsdale M, Achor T, Zelicof S, Asprinio DE. Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma. Apr 2009;23(4):243-8. [Medline].

  4. Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction. J Bone Joint Surg. 1964;46A:1615-38.

  5. Letournel E. Fractures of the Acetabulum. 2nd ed. New York. Springer-Verlag;1993.

  6. Letournel E. Acetabulum fractures: classification and management. Clin Orthop. Sep 1980;(151):81-106. [Medline].

  7. Hadley NA, Brown TD, Weinstein SL. The effects of contact pressure elevations and aseptic necrosis on the long-term outcome of congenital hip dislocation. J Orthop Res. Jul 1990;8(4):504-13. [Medline].

  8. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. Nov 1996;78(11):1632-45. [Medline].

  9. Dakin GJ, Eberhardt AW, Alonso JE, et al. Acetabular fracture patterns: associations with motor vehicle crash information. J Trauma. Dec 1999;47(6):1063-71. [Medline].

  10. Peltier LF. Complications associated with fractures of the Pelvis. J Bone Joint Surg. 1962;44B:550-561.

  11. Reed MH. Pelvic fractures in children. J Can Assoc Radiol. Dec 1976;27(4):255-61. [Medline].

  12. Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. Jan 2002;84-A(1):1-9. [Medline].

  13. Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop. Feb 2003;173-86. [Medline].

  14. Porter SE, Schroeder AC, Dzugan SS, Graves ML, Zhang L, Russell GV. Acetabular fracture patterns and their associated injuries. J Orthop Trauma. Mar 2008;22(3):165-70. [Medline].

  15. Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum. Early results of a prospective study. Clin Orthop. Apr 1986;(205):241-50. [Medline].

  16. Olson SA, Bay BK, Chapman MW, Sharkey NA. Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum. J Bone Joint Surg Am. Aug 1995;77(8):1184-92. [Medline].

  17. Vrahas MS, Widding KK, Thomas KA. The effects of simulated transverse, anterior column, and posterior column fractures of the acetabulum on the stability of the hip joint. J Bone Joint Surg Am. Jul 1999;81(7):966-74. [Medline].

  18. Thacker M. Post-operative management of acetabular fractures. Indian J Orthopaedics. 2002;36(1):29-30.

  19. Olson SA, Matta JM. The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report). J Orthop Trauma. 1993;7(5):402-13. [Medline].

  20. Matta J. Operative indications and choice of surgical approach for fractures of the acetabulum. Tech Orthop. 1986;1:13-22.

  21. Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum. A retrospective analysis. Clin Orthop. Apr 1986;(205):230-40. [Medline].

  22. Øvre S, Madsen JE, Røise O. Acetabular fracture displacement, roof arc angles and 2 years outcome. Injury. Aug 2008;39(8):922-31. [Medline].

  23. Brumback RJ, Holt ES, McBride MS, et al. Acetabular depression fracture accompanying posterior fracture dislocation of the hip. J Orthop Trauma. 1990;4(1):42-8. [Medline].

  24. Harley JD, Mack LA, Winquist RA. CT of acetabular fractures: comparison with conventional radiography. AJR Am J Roentgenol. Mar 1982;138(3):413-7. [Medline].

  25. Tile M. Fractures of the Pelvis and Acetabulum. Baltimore. Lippincott Williams & Wilkins;1984.

  26. Borrelli J Jr, Peelle M, McFarland E, Evanoff B, Ricci WM. Computer-reconstructed radiographs are as good as plain radiographs for assessment of acetabular fractures. Am J Orthop. Sep 2008;37(9):455-9; discussion 460. [Medline].

  27. Moed BR, Ajibade DA, Israel H. Computed tomography as a predictor of hip stability status in posterior wall fractures of the acetabulum. J Orthop Trauma. Jan 2009;23(1):7-15. [Medline].

  28. Johnson EE, Kay RM, Dorey FJ. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture. Clin Orthop. Aug 1994;(305):88-95. [Medline].

  29. Mears DC, Rubash HE. Extensile exposure of the pelvis. Contemp Orthop. 1983;6:21.

  30. Mears DC, Rubash HE, eds. Pelvic and Acetabular Fractures. New Jersey. Slack Inc;1986.

  31. Ebraheim NA, Patil V, Liu J, Haman SP. Sliding trochanteric osteotomy in acetabular fractures: a review of 30 cases. Injury. Oct 2007;38(10):1177-82. [Medline].

  32. Helfet DL, Schmeling GJ. Management of complex acetabular fractures through single nonextensile exposures. Clin Orthop. Aug 1994;(305):58-68. [Medline].

  33. Routt ML Jr, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg Am. Jul 1990;72(6):897-904. [Medline].

  34. Schmidt CC, Gruen GS. Non-extensile surgical approaches for two-column acetabular fractures. J Bone Joint Surg Br. Jul 1993;75(4):556-61. [Medline].

  35. Harris AM, Althausen P, Kellam JF, Bosse MJ. Simultaneous anterior and posterior approaches for complex acetabular fractures. J Orthop Trauma. Aug 2008;22(7):494-7. [Medline].

  36. Bosse MJ, Poka A, Reinert CM, et al. Preoperative angiographic assessment of the superior gluteal artery in acetabular fractures requiring extensile surgical exposures. J Orthop Trauma. 1988;2(4):303-7. [Medline].

  37. Juliano PJ, Bosse MJ, Edwards KJ. The superior gluteal artery in complex acetabular procedures. A cadaveric angiographic study. J Bone Joint Surg Am. Feb 1994;76(2):244-8. [Medline].

  38. Reinert CM, Bosse MJ, Poka A, et al. A modified extensile exposure for the treatment of complex or malunited acetabular fractures. J Bone Joint Surg Am. Mar 1988;70(3):329-37. [Medline].

  39. Clement B. Master Techniques in Orthopedic Surgery: The Hip. Lippincott Williams & Wilkins;1998.

  40. Ganorkar S, Thacker M, Thakkar CJ. Implant selection and placement in acetabular fractures. Indian J Orthopaedics. 2002;36(1):29-30.

  41. Gay SB, Sistrom C, Wang GJ, et al. Percutaneous screw fixation of acetabular fractures with CT guidance: preliminary results of a new technique. AJR Am J Roentgenol. Apr 1992;158(4):819-22. [Medline].

  42. Parker PJ, Copeland C. Percutaneous fluoroscopic screw fixation of acetabular fractures. Injury. Nov-Dec 1997;28(9-10):597-600. [Medline].

  43. Starr AJ, Jones AL, Reinert CM, Borer DS. Preliminary results and complications following limited open reduction and percutaneous screw fixation of displaced fractures of the acetabulum. Injury. May 2001;32 Suppl 1:SA45-50. [Medline].

  44. Starr AJ, Reinert CM, Jones AL. Percutaneous fixation of the columns of the acetabulum: a new technique. J Orthop Trauma. Jan 1998;12(1):51-8. [Medline].

  45. Heeg M, Visser JD, Oostvogel HJ. Injuries of the acetabular triradiate cartilage and sacroiliac joint. J Bone Joint Surg Br. Jan 1988;70(1):34-7. [Medline].

  46. Bucholz RW, Ezaki M, Ogden JA. Injury to the acetabular triradiate physeal cartilage. J Bone Joint Surg Am. Apr 1982;64(4):600-9. [Medline].

  47. Dora C, Zurbach J, Hersche O, Ganz R. Pathomorphologic characteristics of posttraumatic acetabular dysplasia. J Orthop Trauma. Sep-Oct 2000;14(7):483-9. [Medline].

  48. Weber M, Berry DJ, Harmsen WS. Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Joint Surg Am. Sep 1998;80(9):1295-305. [Medline].

  49. Bellabarba C, Berger RA, Bentley CD, et al. Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am. Jun 2001;83-A(6):868-76. [Medline].

  50. Bartlett CS, DiFelice GS, Buly RL. Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture. J Orthop Trauma. May 1998;12(4):294-9. [Medline].

  51. Haidukewych GJ, Scaduto J, Herscovici D Jr, et al. Iatrogenic nerve injury in acetabular fracture surgery: a comparison of monitored and unmonitored procedures. J Orthop Trauma. May 2002;16(5):297-301. [Medline].

  52. Helfet DL, Anand N, Malkani AL, et al. Intraoperative monitoring of motor pathways during operative fixation of acute acetabular fractures. J Orthop Trauma. Jan 1997;11(1):2-6. [Medline].

  53. Middlebrooks ES, Sims SH, Kellam JF, Bosse MJ. Incidence of sciatic nerve injury in operatively treated acetabular fractures without somatosensory evoked potential monitoring. J Orthop Trauma. Jul 1997;11(5):327-9. [Medline].

  54. Johnson EE, Eckardt JJ, Letournel E. Extrinsic femoral artery occlusion following internal fixation of an acetabular fracture. A case report. Clin Orthop. Apr 1987;(217):209-13. [Medline].

  55. Probe R, Reeve R, Lindsey RW. Femoral artery thrombosis after open reduction of an acetabular fracture. Clin Orthop. Oct 1992;(283):258-60. [Medline].

  56. Burd TA, Lowry KJ, Anglen JO. Indomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fractures. J Bone Joint Surg Am. Dec 2001;83-A(12):1783-8. [Medline].

  57. Kendoff D, Gardner MJ, Citak M, Kfuri M Jr, Thumes B, Krettek C. Value of 3D fluoroscopic imaging of acetabular fractures comparison to 2D fluoroscopy and CT imaging. Arch Orthop Trauma Surg. Aug 7 2007;[Medline].

  58. Moed BR, Karges DE. Prophylactic indomethacin for the prevention of heterotopic ossification after acetabular fracture surgery in high-risk patients. J Orthop Trauma. 1994;8(1):34-9. [Medline].

  59. Johnson EE, Matta JM, Mast JW, Letournel E. Delayed reconstruction of acetabular fractures 21-120 days following injury. Clin Orthop. Aug 1994;(305):20-30. [Medline].

  60. Wright R, Barrett K, Christie MJ, Johnson KD. Acetabular fractures: long-term follow-up of open reduction and internal fixation. J Orthop Trauma. Oct 1994;8(5):397-403. [Medline].

  61. Mayo KA. Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures. Clin Orthop. Aug 1994;(305):31-7. [Medline].

  62. Pennal GF, Davidson J, Garside H, Plewes J. Results of treatment of acetabular fractures. Clin Orthop. Sep 1980;(151):115-23. [Medline].

  63. Ragnarsson B, Mjoberg B. Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases. Acta Orthop Scand. Oct 1992;63(5):511-4. [Medline].

  64. Brown GA, Firoozbakhsh K, Gehlert RJ. Three-dimensional CT modeling versus traditional radiology techniques in treatment of acetabular fractures. Iowa Orthop J. 2001;21:20-4. [Medline].

  65. Citak M, Gardner MJ, Kendoff D, Tarte S, Krettek C, Nolte LP, et al. Virtual 3D planning of acetabular fracture reduction. J Orthop Res. Apr 2008;26(4):547-52. [Medline].

[ CLOSE WINDOW ]

Keywords

acetabulum fractures, acetabulum trauma, acetabular trauma, femur trauma, femoral trauma, fractures of the hip socket, intra-articular fractures of the hip, hip fracture, broken hip, hip pain, Arbeitsgemeinschaft für osteosynthesefragen–Association for the Study of Internal Fixation, AO-ASIF, femoral head fractures, femoral neck fractures, intertrochanteric fractures, trochanteric fractures, subtrochanteric fractures, hip joint, iliofemoral ligament, pubofemoral ligament, ischiofemoral ligament, intracapsular fracture, extracapsular fracture, anterior dislocation, posterior dislocation, single fragment fracture, comminuted fracture, stress fracture, incomplete fracture, impacted fracture, partially displaced fracture, completely displaced fracture, single fracture lines,multiple fracture lines, nondisplaced fracture

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho, Assistant Professor of Orthopedic Surgery and Pediatrics, Thomas Jefferson University; Consulting Staff, Department of Pediatric Orthopedic Surgery, Alfred I duPont Hospital for Children; Orthopedic Oncologist, Helen F Graham Cancer Center and Christiana Care Health Services
Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho is a member of the following medical societies: Children's Oncology Group, Limb Lengthening and Reconstruction Society ASAMI-North America, Medical Council of India, and Musculoskeletal Tumor Society
Disclosure: Nothing to disclose.

Coauthor(s)

Nirmal Tejwani, MD, MPA, Associate Professor of Orthopedic Surgery, New York University Hospital for Joint Diseases; Chief of Orthopedic Trauma, Bellevue Hospital
Nirmal Tejwani, MD, MPA is a member of the following medical societies: AO Foundation and Orthopaedic Trauma Association
Disclosure: Stryker Honoraria Speaking and teaching; Zimmer Honoraria Speaking and teaching

Chandrashekhar Thakkar, MBBS, Professor of Orthopedics, Lokmanya tilak Municipal Medical College, University of Mumbai, India
Chandrashekhar Thakkar, MBBS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AO Foundation, Orthopaedic Research Society, Orthopaedic Trauma Association, Orthopaedics Overseas, and Trauma Association of Canada
Disclosure: Nothing to disclose.

Medical Editor

B Sonny Bal, MD, Associate Professor, Department of Orthopedic Surgery, University of Missouri School of Medicine
B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James J McCarthy, MD, FAAOS, FAAP, Associate Professor, Consulting Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health;
James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Orthopaedic Association, Limb Lengthening and Reconstruction Society ASAMI-North America, Orthopaedics Overseas, Pediatric Orthopaedic Society of North America, Pennsylvania Medical Society, Pennsylvania Orthopaedic Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William L Jaffe, MD, Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases
William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine
Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

RELATED EMEDICINE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.