Acetabulum Fractures Clinical Presentation

Updated: Nov 28, 2018
  • Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho; Chief Editor: William L Jaffe, MD  more...
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Presentation

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. [20, 21]

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). [22]  One must diligently look for these injuries, as 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 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