History and Physical Examination

The nature and mechanism of injury help predict the fracture pattern and the associated injuries. The premorbid level of function and status of the joint should be established. In the presence of preexistent arthrosis, a total hip replacement may be a better option than open reduction of the acetabular fracture.^{[23, 24]}

Associated injuries are also important to assess. Patients often have multiple traumatic injuries, and a high likelihood of associated injury exists (in as many as 50% of patients).^[25] One must diligently look for these injuries; some are subtle and can be missed.

Assess the following:

Vital parameters - Life-threatening injuries to the chest, abdomen, and cranium must be the first priority; the basic principles of trauma care and resuscitation apply because many acetabular fractures are associated with severe trauma
Associated injuries - Associated limb injuries may be in the form of a patella or upper tibial fracture or a posterior cruciate ligament (PCL) injury, indicating the mechanism of injury; associated femoral shaft fractures may also be present, which could have a bearing on the management of the acetabular fracture; associated concomitant pelvic fractures may be present in up to 20% of patients
It is also important to exclude injury to the bowel and the urinary tract, in that such injuries influence decision-making about an open reduction of the acetabular fracture

The local orthopedic examination includes an assessment of the following:

Position of the lower limb - In a posterior dislocation, it is adducted, flexed, and internally rotated; in an anterior dislocation, it is is abducted and externally rotated; eversion of the iliac wing, with the anterior superior iliac spine (ASIS) on the affected side being more laterally placed, is a subtle clue to a central dislocation
Skin - Including local wounds, abrasions, and closed degloving injury
Morel-Lavele lesion - A closed degloving injury occurring over the greater trochanter, in which the subcutaneous tissue is torn from underlying fascia creating a cavity, which places this tissue at risk for infection and/or poor healing
Abduction and adduction of the hip - To detect instability (manual traction can aid in determination of vertical instability)
Limb-length inequality - May be a subtle clue to the presence of incarcerated intra-articular fragments
Neurologic examination - To exclude preoperative sciatic/lateral popliteal nerve palsy

Workup

Hoge S, Chauvin BJ. Acetabular Fractures. Treasure Island, FL: StatPearls; 2022. [Full Text].
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. 1990 Jul. 8 (4):504-13. [QxMD MEDLINE Link].
JUDET R, JUDET J, LETOURNEL E. FRACTURES OF THE ACETABULUM: CLASSIFICATION AND SURGICAL APPROACHES FOR OPEN REDUCTION. PRELIMINARY REPORT. J Bone Joint Surg Am. 1964 Dec. 46:1615-46. [QxMD MEDLINE Link].
Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. New York: Springer-Verlag; 1993.
Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980 Sep. (151):81-106. [QxMD MEDLINE Link].
Milenković S, Saveski J, Radenković M, Vidić G, Trajkovska N. Surgical treatment of displaced acetabular fractures. Srp Arh Celok Lek. 2011 Jul-Aug. 139 (7-8):496-500. [QxMD MEDLINE Link].
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. 1999 Jul. 81 (7):966-74. [QxMD MEDLINE Link].
Thacker M. Post-operative management of acetabular fractures. Indian J Orthop. 2002. 36 (1):29-30.
Kellam JF, Meinberg EG, Agel J, Karam MD, Roberts CS. Introduction: Fracture and Dislocation Classification Compendium-2018: International Comprehensive Classification of Fractures and Dislocations Committee. J Orthop Trauma. 2018 Jan. 32 Suppl 1:S1-S10. [QxMD MEDLINE Link].
Heeg M, Visser JD, Oostvogel HJ. Injuries of the acetabular triradiate cartilage and sacroiliac joint. J Bone Joint Surg Br. 1988 Jan. 70 (1):34-7. [QxMD MEDLINE Link].
Bucholz RW, Ezaki M, Ogden JA. Injury to the acetabular triradiate physeal cartilage. J Bone Joint Surg Am. 1982 Apr. 64 (4):600-9. [QxMD MEDLINE Link].
Dora C, Zurbach J, Hersche O, Ganz R. Pathomorphologic characteristics of posttraumatic acetabular dysplasia. J Orthop Trauma. 2000 Sep-Oct. 14 (7):483-9. [QxMD MEDLINE Link].
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. 1996 Nov. 78 (11):1632-45. [QxMD MEDLINE Link].
Dakin GJ, Eberhardt AW, Alonso JE, Stannard JP, Mann KA. Acetabular fracture patterns: associations with motor vehicle crash information. J Trauma. 1999 Dec. 47 (6):1063-71. [QxMD MEDLINE Link].
PELTIER LF. COMPLICATIONS ASSOCIATED WITH FRACTURES OF THE PELVIS. J Bone Joint Surg Am. 1965 Jul. 47:1060-9. [QxMD MEDLINE Link].
Reed MH. Pelvic fractures in children. J Can Assoc Radiol. 1976 Dec. 27 (4):255-61. [QxMD MEDLINE Link].
Kelly J, Ladurner A, Rickman M. Surgical management of acetabular fractures - A contemporary literature review. Injury. 2020 Oct. 51 (10):2267-2277. [QxMD MEDLINE Link].
Shim VB, Böshme J, Vaitl P, Josten C, Anderson IA. An efficient and accurate prediction of the stability of percutaneous fixation of acetabular fractures with finite element simulation. J Biomech Eng. 2011 Sep. 133 (9):094501. [QxMD MEDLINE Link].
Wright R, Barrett K, Christie MJ, Johnson KD. Acetabular fractures: long-term follow-up of open reduction and internal fixation. J Orthop Trauma. 1994 Oct. 8 (5):397-403. [QxMD MEDLINE Link].
Mayo KA. Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures. Clin Orthop Relat Res. 1994 Aug. (305):31-7. [QxMD MEDLINE Link].
Pennal GF, Davidson J, Garside H, Plewes J. Results of treatment of acetabular fractures. Clin Orthop Relat Res. 1980 Sep. (151):115-23. [QxMD MEDLINE Link].
Ragnarsson B, Mjöberg B. Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases. Acta Orthop Scand. 1992 Oct. 63 (5):511-4. [QxMD MEDLINE Link].
Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am. 2002 Jan. 84-A (1):1-9. [QxMD MEDLINE Link].
Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res. 2003 Feb. 173-86. [QxMD MEDLINE Link].
Porter SE, Schroeder AC, Dzugan SS, Graves ML, Zhang L, Russell GV. Acetabular fracture patterns and their associated injuries. J Orthop Trauma. 2008 Mar. 22 (3):165-70. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Matta J. Operative indications and choice of surgical approach for fractures of the acetabulum. Tech Orthop. 1986. 1:13-22.
Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res. 1986 Apr. (205):230-40. [QxMD MEDLINE Link].
Øvre S, Madsen JE, Røise O. Acetabular fracture displacement, roof arc angles and 2 years outcome. Injury. 2008 Aug. 39 (8):922-31. [QxMD MEDLINE Link].
Brumback RJ, Holt ES, McBride MS, Poka A, Bathon GH, Burgess AR. Acetabular depression fracture accompanying posterior fracture dislocation of the hip. J Orthop Trauma. 1990. 4 (1):42-8. [QxMD MEDLINE Link].
Harley JD, Mack LA, Winquist RA. CT of acetabular fractures: comparison with conventional radiography. AJR Am J Roentgenol. 1982 Mar. 138 (3):413-7. [QxMD MEDLINE Link].
Tile M. Fractures of the Pelvis and Acetabulum. Baltimore: Lippincott Williams & Wilkins; 1984.
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 (Belle Mead NJ). 2008 Sep. 37 (9):455-9; discussion 460. [QxMD MEDLINE Link].
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. 2009 Jan. 23 (1):7-15. [QxMD MEDLINE Link].
Gebre RK, Hirvasniemi J, Lantto I, Saarakkala S, Leppilahti J, Jämsä T. Discrimination of Low-Energy Acetabular Fractures from Controls Using Computed Tomography-Based Bone Characteristics. Ann Biomed Eng. 2021 Jan. 49 (1):367-381. [QxMD MEDLINE Link].
Li BF, Zhang Y, Tai GL, Dai YY, Xie HB, Guo XZ, et al. [Application of 3D digital orthopedic techniques in treatment of acetabular fracture]. Nan Fang Yi Ke Da Xue Xue Bao. 2016 Jun 20. 36 (7):1014-7. [QxMD MEDLINE Link].
Meesters AML, Oldhoff MGE, Trouwborst NM, Assink N, Kraeima J, Witjes MJH, et al. Quantitative Three-Dimensional Measurements of Acetabular Fracture Displacement Could Be Predictive for Native Hip Survivorship. J Pers Med. 2022 Sep 6. 12 (9):[QxMD MEDLINE Link]. [Full Text].
Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum. Early results of a prospective study. Clin Orthop Relat Res. 1986 Apr. (205):241-50. [QxMD MEDLINE Link].
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. 1995 Aug. 77 (8):1184-92. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Citak M, Gardner MJ, Kendoff D, Tarte S, Krettek C, Nolte LP, et al. Virtual 3D planning of acetabular fracture reduction. J Orthop Res. 2008 Apr. 26 (4):547-52. [QxMD MEDLINE Link].
Johnson EE, Kay RM, Dorey FJ. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture. Clin Orthop Relat Res. 1994 Aug. (305):88-95. [QxMD MEDLINE Link].
Dailey SK, Archdeacon MT. Open reduction and internal fixation of acetabulum fractures: does timing of surgery affect blood loss and OR time?. J Orthop Trauma. 2014 Sep. 28 (9):497-501. [QxMD MEDLINE Link].
Mears DC, Rubash HE. Extensile exposure of the pelvis. Contemp Orthop. 1983. 6:21.
Mears DC. Pelvic and Acetabular Fractures. Thorofare, NJ: Slack Inc; 1986.
Dean DB, Moed BR. Late salvage of failed open reduction and internal fixation of posterior wall fractures of the acetabulum. J Orthop Trauma. 2009 Mar. 23 (3):180-5. [QxMD MEDLINE Link].
Isaacson MJ, Taylor BC, French BG, Poka A. Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes. Clin Orthop Relat Res. 2014 Nov. 472 (11):3345-52. [QxMD MEDLINE Link]. [Full Text].
Bastian JD, Savic M, Cullmann JL, Zech WD, Djonov V, Keel MJ. Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. Injury. 2016 Mar. 47 (3):695-701. [QxMD MEDLINE Link].
Kwak DK, Lee SH, Lee KU, Hwang JH, Yoo JH. Simultaneous reduction and fixation using an anatomical suprapectineal quadrilateral surface plate through modified Stoppa approach in superomedially displaced acetabular fractures. Sci Rep. 2022 Sep 8. 12 (1):15221. [QxMD MEDLINE Link]. [Full Text].
Aprato A, Sallam A, Di Benedetto P, Giaretta S, Massè A. Arthroscopic reduction and fixation of partial posterior wall acetabular fractures. Acta Biomed. 2022 Mar 10. 92 (S3):e2021551. [QxMD MEDLINE Link]. [Full Text].
Ebraheim NA, Patil V, Liu J, Haman SP. Sliding trochanteric osteotomy in acetabular fractures: a review of 30 cases. Injury. 2007 Oct. 38 (10):1177-82. [QxMD MEDLINE Link].
Rollmann MF, Holstein JH, Pohlemann T, Herath SC, Histing T, Braun BJ, et al. Predictors for secondary hip osteoarthritis after acetabular fractures-a pelvic registry study. Int Orthop. 2019 Sep. 43 (9):2167-2173. [QxMD MEDLINE Link].
Rommens PM, Schwab R, Handrich K, Arand C, Wagner D, Hofmann A. Open reduction and internal fixation of acetabular fractures in patients of old age. Int Orthop. 2020 Oct. 44 (10):2123-2130. [QxMD MEDLINE Link].
Collinge C, Archdeacon M, Sagi HC. Quality of radiographic reduction and perioperative complications for transverse acetabular fractures treated by the Kocher-Langenbeck approach: prone versus lateral position. J Orthop Trauma. 2011 Sep. 25 (9):538-42. [QxMD MEDLINE Link].
Helfet DL, Schmeling GJ. Management of complex acetabular fractures through single nonextensile exposures. Clin Orthop Relat Res. 1994 Aug. (305):58-68. [QxMD MEDLINE Link].
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. 1990 Jul. 72 (6):897-904. [QxMD MEDLINE Link].
Schmidt CC, Gruen GS. Non-extensile surgical approaches for two-column acetabular fractures. J Bone Joint Surg Br. 1993 Jul. 75 (4):556-61. [QxMD MEDLINE Link].
Harris AM, Althausen P, Kellam JF, Bosse MJ. Simultaneous anterior and posterior approaches for complex acetabular fractures. J Orthop Trauma. 2008 Aug. 22 (7):494-7. [QxMD MEDLINE Link].
Bosse MJ, Poka A, Reinert CM, Brumback RJ, Bathon H, Burgess AR. Preoperative angiographic assessment of the superior gluteal artery in acetabular fractures requiring extensile surgical exposures. J Orthop Trauma. 1988. 2 (4):303-7. [QxMD MEDLINE Link].
Juliano PJ, Bosse MJ, Edwards KJ. The superior gluteal artery in complex acetabular procedures. A cadaveric angiographic study. J Bone Joint Surg Am. 1994 Feb. 76 (2):244-8. [QxMD MEDLINE Link].
Reinert CM, Bosse MJ, Poka A, Schacherer T, Brumback RJ, Burgess AR. A modified extensile exposure for the treatment of complex or malunited acetabular fractures. J Bone Joint Surg Am. 1988 Mar. 70 (3):329-37. [QxMD MEDLINE Link].
Sledge CB, ed. Master Techniques in Orthopaedic Surgery: The Hip. New York: Raven; 1998.
Ganorkar S, Thacker M, Thakkar CJ. Implant selection and placement in acetabular fractures. Indian J Orthop. 2002. 36 (1):29-30.
Hsu CL, Chou YC, Li YT, Chen JE, Hung CC, Wu CC, et al. Pre-operative virtual simulation and three-dimensional printing techniques for the surgical management of acetabular fractures. Int Orthop. 2019 Aug. 43 (8):1969-1976. [QxMD MEDLINE Link].
Mehin R, Jones B, Zhu Q, Broekhuyse H. A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg. 2009 Jun. 52 (3):221-8. [QxMD MEDLINE Link]. [Full Text].
Gay SB, Sistrom C, Wang GJ, Kahler DA, Boman T, McHugh N, et al. Percutaneous screw fixation of acetabular fractures with CT guidance: preliminary results of a new technique. AJR Am J Roentgenol. 1992 Apr. 158 (4):819-22. [QxMD MEDLINE Link].
Parker PJ, Copeland C. Percutaneous fluoroscopic screw fixation of acetabular fractures. Injury. 1997 Nov-Dec. 28 (9-10):597-600. [QxMD MEDLINE Link].
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. 2001 May. 32 Suppl 1:SA45-50. [QxMD MEDLINE Link].
Starr AJ, Reinert CM, Jones AL. Percutaneous fixation of the columns of the acetabulum: a new technique. J Orthop Trauma. 1998 Jan. 12 (1):51-8. [QxMD MEDLINE Link].
Li J, Li Z, Wang X, Zhang G, Peng Y, Zhang S, et al. Establishment of fluoroscopy views and standardized procedure of percutaneous magic screw insertion for acetabulum fractures. BMC Musculoskelet Disord. 2018 Sep 12. 19 (1):332. [QxMD MEDLINE Link]. [Full Text].
Zhang P, Tang J, Dong Y, Lu L, Wang S, Song S, et al. A new navigational apparatus for fixation of acetabular posterior column fractures with percutaneous retrograde lagscrew: Design and application. Medicine (Baltimore). 2018 Sep. 97 (36):e12134. [QxMD MEDLINE Link]. [Full Text].
Kazemi N, Archdeacon MT. Immediate full weightbearing after percutaneous fixation of anterior column acetabulum fractures. J Orthop Trauma. 2012 Feb. 26 (2):73-9. [QxMD MEDLINE Link].
Mauffrey C, Hake M, Kim FJ. Flexible 3D laparoscopic assisted reduction and percutaneous fixation of acetabular fractures: Introduction to a new surgical option. Injury. 2016 Oct. 47 (10):2203-2211. [QxMD MEDLINE Link].
Weber M, Berry DJ, Harmsen WS. Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Joint Surg Am. 1998 Sep. 80 (9):1295-305. [QxMD MEDLINE Link].
Bellabarba C, Berger RA, Bentley CD, Quigley LR, Jacobs JJ, Rosenberg AG, et al. Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am. 2001 Jun. 83-A (6):868-76. [QxMD MEDLINE Link].
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. 2009 Apr. 23 (4):243-8. [QxMD MEDLINE Link].
Haidukewych GJ, Scaduto J, Herscovici D Jr, Sanders RW, DiPasquale T. Iatrogenic nerve injury in acetabular fracture surgery: a comparison of monitored and unmonitored procedures. J Orthop Trauma. 2002 May. 16 (5):297-301. [QxMD MEDLINE Link].
Helfet DL, Anand N, Malkani AL, Heise C, Quinn TJ, Green DS, et al. Intraoperative monitoring of motor pathways during operative fixation of acute acetabular fractures. J Orthop Trauma. 1997 Jan. 11 (1):2-6. [QxMD MEDLINE Link].
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. 1997 Jul. 11 (5):327-9. [QxMD MEDLINE Link].
Johnson EE, Eckardt JJ, Letournel E. Extrinsic femoral artery occlusion following internal fixation of an acetabular fracture. A case report. Clin Orthop Relat Res. 1987 Apr. (217):209-13. [QxMD MEDLINE Link].
Probe R, Reeve R, Lindsey RW. Femoral artery thrombosis after open reduction of an acetabular fracture. Clin Orthop Relat Res. 1992 Oct. (283):258-60. [QxMD MEDLINE Link].
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. 2001 Dec. 83-A (12):1783-8. [QxMD MEDLINE Link].
Kendoff D, Gardner MJ, Citak M, Kfuri M Jr, Thumes B, Krettek C, et al. Value of 3D fluoroscopic imaging of acetabular fractures comparison to 2D fluoroscopy and CT imaging. Arch Orthop Trauma Surg. 2008 Jun. 128 (6):599-605. [QxMD MEDLINE Link].
Maini L, Kumar S, Batra S, Gupta R, Arora S. Evaluation of the muscle morphology of the obturator externus and piriformis as the predictors of avascular necrosis of the femoral head in acetabular fractures. Strategies Trauma Limb Reconstr. 2016 Aug. 11 (2):105-11. [QxMD MEDLINE Link].
Yeung P, Zarnett O, Lefaivre KA, Guy P. Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures: A Systematic Review. JBJS Rev. 2022 Sep 1. 10 (9):[QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Johnson EE, Matta JM, Mast JW, Letournel E. Delayed reconstruction of acetabular fractures 21-120 days following injury. Clin Orthop Relat Res. 1994 Aug. (305):20-30. [QxMD MEDLINE Link].
Bartlett CS, DiFelice GS, Buly RL, Quinn TJ, Green DS, Helfet DL. 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. 1998 May. 12 (4):294-9. [QxMD MEDLINE Link].

Media Gallery

Posterior wall fracture with a posterior dislocation of the hip.
Posterior wall fracture preoperative obturator view.
Three-dimensional (3-D) CT scan showing a posterior wall fracture.
Anterior wall fracture.
Anterior wall fracture: Three-dimensional reconstruction.
Transverse fracture.
Posterior lip with posterior column injury, anteroposterior view.
Posterior wall with posterior column fracture, 3-D reconstruction.
Transverse with posterior lip fracture.
T-shaped fracture (break in the margins of the obturator foramen).
T-shaped fracture, obturator view.
Both-column fracture, 3-D reconstruction, anteroposterior view.
Both-column fracture, 3-D reconstruction, iliac view.
Both-column fracture, 3-D reconstruction, obturator view.
The Arbeitsgemeinschaft fur osteosynthesefragen–Association for the Study of Internal Fixation (AO-ASIF) classification.
Columns of the acetabulum, anteroposterior view. The white area is the anterior column, the red area is the posterior column, and the purple area is the tie beam (inferior pubic ramus).
Columns of the acetabulum, iliac view.
Columns of the acetabulum, obturator view.
Bilateral acetabular fractures with posterior dislocations.
Incarcerated fragment best seen on axial cuts of the CT scan.
Transverse fracture, iliac view. Also note the impaction fracture on the femoral head.
Incision for the Kocher-Langenbeck approach.
Kocher-Langenbeck approach.
Trochanteric osteotomy to increase the exposure during a Kocher-Langenbeck approach.
Ilioinguinal approach: Femoral vessels and the iliopsoas looped with catheters. The 3 windows of the ilioinguinal approach: Lateral to the iliopsoas, between the iliopsoas and the vessels, and between the vessels and the spermatic cord. (The lateral femoral cutaneous nerve is seen traversing lateral to the iliopsoas toward the anterior superior iliac spine.)
Ilioinguinal approach: Anterior column plate.
The triradiate approach.
Fixation of posterior wall fracture: Bone model showing the direction of screws and application of neutralization/buttress plate.
Posterior wall fracture: Postoperative anteroposterior (AP) view.
Posterior lip fracture: Postoperative iliac view.
Posterior wall fracture: Postoperative obturator view.
Transverse fracture.
T-shaped fracture (note the use of the anterior-to-posterior lag screw to hold the posterior column).
Both-column fracture.
Quadrilateral surface comminution: Use of a T-plate.
Use of femoral distractor during surgery.
Total hip replacement in posttraumatic arthritis after an acetabular fracture.
Intra-articular screw as seen on the axial cut of the CT scan.

of 38

Author

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho Associate Professor of Orthopedic Surgery and Pediatrics, Jefferson Medical College of 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, Medical Council of India, Musculoskeletal Tumor Society, Pediatric Orthopaedic Society of North America, Limb Lengthening and Reconstruction Society

Disclosure: Nothing to disclose.

Coauthor(s)

Nirmal Tejwani, MD, MPA 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: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AO Foundation, Orthopaedic Trauma Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Orthopedic Trauma Association Board of directors.<br/>Received honoraria from Stryker for speaking and teaching; Received honoraria from Zimmer for speaking and teaching; for: Stryker; Zimmer.

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, Orthopaedic Trauma Association, Orthopaedic Research Society, AO Foundation, Trauma Association of Canada, Orthopaedics Overseas

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

James J McCarthy, MD, FAAOS, FAAP Director, Division of Orthopedic Surgery, Cincinnati Children's Hospital; Professor, Department of Orthopedic Surgery, University of Cincinnati College of Medicine

James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Orthopaedic Association, Pennsylvania Medical Society, Philadelphia County Medical Society, Pennsylvania Orthopaedic Society, Pediatric Orthopaedic Society of North America, Orthopaedics Overseas, Limb Lengthening and Reconstruction Society, Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Orthopediatrics, Phillips Healthcare, POSNA<br/>Serve(d) as a speaker or a member of a speakers bureau for: Synthes<br/>Received research grant from: University of Cincinnati<br/>Received royalty from Lippincott Williams and WIcins for editing textbook; Received none from POSNA for board membership; Received none from LLRS for board membership; Received consulting fee from Synthes for none.

Chief Editor

William L Jaffe, MD Clinical Professor of Orthopedic Surgery, New York University Grossman 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, New York Academy of Medicine

Disclosure: Received consulting fee from Stryker Orthopaedics for speaking and teaching.

Additional Contributors

B Sonny Bal, MD, JD, PhD, MBA CEO and President, SINTX Technologies, Salt Lake City, UT

B Sonny Bal, MD, JD, PhD, MBA is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: SINTX Technologies.

Fracture type	Letournel, ^[4] % (n = 567)	Matta, ^[13] % (n = 255)	Dakin et al, ^[14] % (n = 85)
Both columns	27.9	33.3	14.1
Transverse with posterior wall	20.6	23.5	35.3
Posterior wall	22.4	8.6	12.9
T-shaped	5.3	12.2	3.5
Transverse	3.7	3.5	8.2
Anterior column	3.9	4.7	1.2
Anterior column with posterior hemitransverse	8.8	5.9	3.5
Posterior column with posterior wall	3.5	3.9	18.8
Posterior column	2.3	3.1	1.2
Anterior wall	1.6	1.2	1.2

Acetabulum Fractures Clinical Presentation

History and Physical Examination

References

Tables

Contributor Information and Disclosures

What would you like to print?