This module shows step-by-step descriptions of
- Patient preparation
- Reduction & fixation
for all acetabular fractures of the Letournel classification system.
In addition, there are videos, animations, journal articles and book chapters from AO publications
Authored by Keith Mayo, Pol Rommens, Carlos Sancineto, Michel Oransky, Executive editor: Peter Trafton
Thacker, Tejwani & Thakkar 2008
Fractures of the acetabulum occur primarily in young adults as a result of high-velocity trauma. These fractures are often associated with other life-threatening injuries.
Displacement of the fracture fragments leads to articular incongruity of the hip joint that results in abnormal pressure distribution on the articular cartilage surface. This can lead to rapid breakdown of the cartilage surface, resulting in disabling arthritis of the hip joint. Anatomic reduction and stable fixation of the fracture, such that the femoral head is concentrically reduced under an adequate portion of the weight-bearing dome of the acetabulum, is the treatment goal in these difficult fractures.
As a result of reading this article, physicians should be able to:
Describe the anatomy and mechanism of injury associated with apophyseal avulsion fractures of the hip and pelvis.
List the different stages of nonoperative management in patients with apophyseal avulsion.
Discuss the operative treatment options and surgical approaches for treatment of these injuries.
Identify the controversies and common complications in the treatment of apophyseal avulsion fractures of the hip and pelvis.
This activity is approved for one year from the date of original release, January 2009 to January 2010.
Bart I. McKinney, MD; Cory Nelson, MD; Wesley Carrion, MD
ORTHOPEDICS 2009; 32:42
The pelvis is a ring-like structure of bones at the lower end of the trunk. The two sides of the pelvis are actually three bones (ilium, ischium, and pubis) that grow together as people age. Strong connective tissues (ligaments) join the pelvis to the large triangular bone (sacrum) at the base of the spine. This creates a bowl-like cavity below the rib cage. On each side, there is a hollow cup (acetabulum) that serves as the socket for the hip joint.
With of the vital structures running through the pelvis, a pelvic fracture can be associated with substantial bleeding, nerve injury, and internal organ damage.
Contents - Anatomy
Vertical Shear Fracture of the Pelvis.
- frx consist of frxs of both pubic rami plus posterior frx of SI complex or sacrum:
- there is vertically oriented frx thru anterior and posterior pelvis together w/ superior displacement of lateral "acetabulum-containing" fragment of pelvis;
- this injury is characterized by rupture of entire pelvic floor, including posterior SI complex as well as sacrospinous and sacrotuberous ligaments;
- injury may be unilateral or bilateral;
- these frx are unstable owing to the significant posterior pelvic disruption;
- usually results from fall from height onto lower limbs
Author: Charles Sheppard, MD, FACEP. 2005
Pelvic fracture is a disruption of the bony structure of the pelvis. In elderly persons, the most common cause is a fall from a standing position. However, the most significant fractures involve significant forces such as a motor vehicle crash or fall from a significant height.
Synonyms and related keywords: pelvic fracture, fracture of the pelvis, acetabular fractures, lateral compression fractures, transverse fractures of the pubic rami, avulsion fracture, Young classification system, anterior-posterior compression fractures
Russell & Jarrett 2006
Operative management of unstable pelvic injuries increased especially recently due to several factors. Improved and coordinated treatment of polytraumatized patients, improved anesthetic techniques including blood salvage systems, advances in intraoperative fluoroscopic imaging techniques, standardized pelvic implant system, and better understanding of injury and deformity patterns have allowed for successful operative treatment of patients with pelvic ring injuries. Operative management of unstable pelvic ring injuries allows for earlier patient mobilization, thereby decreasing complications associated with recumbency. Operative management also allows for correction and prevention of significant pelvic deformities, improving clinical outcomes.
Synonyms and related keywords: pelvic ring injuries, broken pelvis, cracked pelvis, shattered pelvis, fractured hip, broken hip
Author: D Dean Thornton, MD 2007
Pelvic ring fractures occur as the result of high-energy blunt trauma, as in motor vehicle collisions and falls. These injuries are associated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. Recognition of the pattern of injury to the bony pelvis directs the search for associated soft-tissue injuries and allows implementation of the appropriate therapy.
Synonyms and related keywords: pelvic fractures, pelvis fractures, blunt trauma, bladder rupture, vertical shear injury, anteroposterior compression injury, AP compression injury, lateral compression injury, pelvic hemorrhage, osseous pelvis, Young-Burgess classification, Tile classification, pubic diastasis, sacral buckle fracture, pubic rami fracture, iliac wing fracture
Graf & Karunakar 2008
This article focuses on unstable pelvic fractures, which are usually caused by high-energy injuries.
The most common high-energy mechanism of injury is a motor vehicle accident. Patients who sustain these injuries not only have the osseous injury but also often have concomitant life-threatening injuries. Younger people are more likely to be involved in these accidents. Early death after these injuries is usually due to hemorrhage, multiple organ system failure, or sepsis. These unstable high-energy pelvic fractures require a multidisciplinary approach to treatment.
Synonyms and related keywords: open-book fractures, Tile type B fractures, anterior-posterior compression injury, APC injury, lateral compression injury, LC injury, vertical shear injury, VS injury, combined mechanism injury, zone I sacral injury, zone II sacral injury, zone III sacral injury, pelvic fracture, fracture of the pelvis, acetabular fractures, lateral compression fractures, transverse fractures of the pubic rami, avulsion fracture, Young classification system, anterior-posterior compression fractures, anteroposterior compression fractures, pelvic ring injuries, broken pelvis, cracked pelvis, shattered pelvis, fractured hip, broken hip