For most displaced acetabulum fractures, surgical reduction is indicated with an aim to decrease the incidence of posttraumatic arthritis.
It also permits the patient to return to normal function earlier than nonoperative treatment.
Nonoperative treatment used in a minority of displaced acetabulum fractures. Indications for nonoperative treatment are based on
- Patient condition
- Fracture configuration
- Congruence of the hip joint.
Nonoperative treatment is reserved for patients with nondisplaced fracture, those with tolerable incongruity or displacement, and those in whom surgery is contraindicated.
Displaced fractures that should be considered for nonoperative treatment are
- A large portion of the acetabulum remains intact and the femoral head remains congruous with this portion of the acetabulum.
- Secondary congruence is present following only moderate displacement.
Many low anterior column fractures involving only the pubic portion of the acetabulum can be treated nonoperatively.
Indications for surgical stabilization include
- Instability or subluxation of the hip
- Associated marginal impaction of the articular surface
- Retained osteochondral fragments with joint incongruence.
There are three degrees of instability of the hip.
- I-The hip is stable
- II-The hip is unstable
- III-Instability is inconsistent
if there is a small posterior wall fractures associated with a stable hip joint -manage conservatively. Careful follow up is needed to monitor for signs and symptoms of late instability in the initial months following injury.
Loss of the normal congruent relationship of the femoral head with the acetabulum is frequently associated with osteochondral fragments incarcerated within the acetabulum.
Loss of congruency between the femoral head and acetabular articular surface is often associated with the development of degenerative arthritis of the hip.
In case of both column fracture loss of parallelism on any of the three views to be an indication for surgery.
Surgery is usually undertaken 2 to 3 days following the injury, when the initial bleeding from the fracture and intrapelvic vessels has subsided. Generally, use skeletal traction preoperatively for posterior fracture patterns with hip instability out of traction.
Advanced age is not an absolute contraindication to surgery. Factors such as general medical status, pre-existing arthrosis, and bone quality may affect making.
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