Lower limb fractures
Acetabular fracturesAcetabulum fractures can involve one or more of the two columns, two walls or roof within the pelvis
Mechanism of injury
high energy trauma in younger patients (e.g., motor vehicle accidents)
low energy trauma in elderly patients (e.g., fall from standing height)Associated conditions
lower extremity injurynerve palsy
spine injury
systemic injuries
head injury
chest injury
abdominal injury
genitourinary injury
corona mortis anastomosis of external iliac (epigastric) and internal iliac (obturator) vessels
at risk with lateral dissection over superior pubic ramus
classifed as 5 elementary and 5 associated fracture patterns
Imaging• Radiographs
• AP
• CT scan
indications
now considered a gold standard in management
Duplex doppler ultrasound
indications
rule out DVT
Treatment
• Nonoperative• protected weight bearing for 6-8 weeks
• indications
• high operative risk (e.g., elderly patients, presence of DVT)
• morbid obesity
• minimally displaced fracture (< 2 mm)
• DVT prophylaxis if slow to mobilize
• close radiographic follow-upOperative treatment
open reduction and internal fixationindications
physiologically stable
no local infection
pregnancy is not contraindication to surgical fixation
displacement of roof (> 2 mm)
intra-articular loose bodies
irreducible fracture-dislocation
total hip arthroplasty indications
usually elderly patients with pre-existing arthritis
post-traumatic arthritis in all ages
Complications
• Post-traumatic DJD• most common complication
• Heterotopic Ossification
• Osteonecrosis
• DVT and PE
• Infection
• Bleeding
• Neurovascular injury
• Intra articular hardware placement
• Abductor muscle weakness
osteonecrosis
Methods of treatment