Hip

Acetabular Fracture

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Acetabular Fracture

  • See Also
  1. Pelvic Fracture
  2. Hip Fracture
  • Epidemiology
  1. Incidence: 3-6% of Pelvic Fractures in the U.S.
  • Pathophysiology
  1. Mechanism
    1. High energy Trauma (e.g. Motor Vehicle Accidents, fall from height)
    2. Older patients with ground level falls
  2. Images
    1. orthoLegPelvisMaleGrayBB241.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
  • Exam
  1. See Primary Trauma Survey
  2. See Secondary Trauma Survey
  3. Complete extremity neurovascular exam
  • Findings
  1. Hip or inguinal pain
  2. Inability to bear weight
  3. Limb deformities including shortening or rotation
  4. Local hip swelling or Ecchymosis
  • Imaging
  1. Pelvic XRay
    1. Often included as part of initial Trauma Evaluation
    2. Judet Views
      1. Obturator oblique xray (acetabular anterior column, posterior wall)
      2. Iliac oblique xray (acetabular Posterior Column, anterior wall)
  2. CT Pelvis (with or without 3D reconstruction)
    1. Preferred evaluation to define Fracture orientation, fragments (ideal for preoperative planning)
  • Types
  • Judet and Letournel System
  1. Elementary Fracture Patterns
    1. Posterior Wall Pattern (common)
      1. Isolated posterior acetabular wall Fracture
      2. Associated with posterior Hip Dislocation
    2. Posterior Column Pattern (common)
      1. Fracture through ischium and extending into posterior acetabulum
    3. Anterior Wall Pattern
      1. Isolated anterior acetabular wall Fracture
    4. Anterior Column Pattern
      1. Fracture through iliopubic region (but sparing Posterior Column)
    5. Transverse Pattern
      1. Horizontal Fracture line through the acetabulum (divides the acetabulum into superior/inferior halves)
      2. Fracture line passes through both the anterior and Posterior Columns
  2. Associated Fracture Patterns (complex combinations and variants)
    1. T-Shaped Pattern
      1. Transverse Fracture with a vertical Fracture limb
    2. Both-Column Pattern (anterior and posterior)
      1. Articular surface is completely detached from the axial skeleton
      2. Neither acetabular column (anterior or posterior) is attached to the Sacrum
    3. Anterior column (or wall) with posterior hemitransverse pattern
      1. Anterior column or wall Fracture AND a transverse Fracture through the Posterior Column
    4. Transverse with posterior wall pattern
      1. Transverse Acetabular Fracture AND a posterior wall Fracture
    5. Posterior Column with posterior wall pattern
      1. Posterior Column AND wall Fracture
  • Management
  1. Hip stability
    1. Performed under Anesthesia and fluoroscopy
    2. Instability identified if hip subluxation or dislocation during passive range of motion (or Hip Joint incongruity)
  2. Surgery
    1. Timing
      1. Typically in first 72 hours for best outcomes (first 12 hours if associated Hip Dislocation)
    2. Indications
      1. Unstable Fractures
      2. Displaced or incongruent Acetabular Fractures
      3. Acetabular Fractures with Hip Dislocation
      4. Intraarticular Fracture fragments
    3. Techniques
      1. Open reduction and internal fixation
      2. Closed reduction
      3. Percutaneous screws
      4. Total hip arthroplasty (older patients with Hip DJD or highly comminuted Fractures)
  3. Nonoperative Management
    1. Indications
      1. Stable, non-displaced and congruent Fractures
    2. Approach
      1. Protected weight bearing
      2. Close interval follow-up with serial imaging
  • Complications
  1. Post-Traumatic Osteoarthritis
  2. Heterotropic ossification
  3. Avascular Necrosis of the Femoral Head
  4. Associated neurovascular injury
  • Prognosis
  1. Varies by Fracture type, associated femoral Head Injury, patient factors (e.g. age, comorbidity)
  2. Best outcomes with elementary Fracture patterns and quality reduction
  • Resources
  1. Acetabular Fractures (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK544315/
  • References
  1. Tran (2025) Crit Dec Emerg Med 39(8): 25-6