On the diagnosis and treatment of acetabular fractures

Abstract

Acetabular fractures are rare injuries with and annual incidence of around 3 per 100 000 persons. Approximately half of these injuries are treated operatively, posing a great challenge to the treating orthopedic surgeon. The radiological work up for patients with a suspected acetabular fracture should include a standard AP radiograph and a CT-scan with reconstructions. If in doubt oblique radiographs can be helpful, since an intraarticular step-off > 2mm is a strong predictor for a negative clinical outcome. Good long-term results can be expected for minimally displaced non-operatively treated acetabular fractures. Loss of joint congruency with an intraarticular step-off > 2mm leads to an inferior outcome. Hip joint survival and clinical outcome for operatively treated patients are generally good, but the presence of cartilage injury to the femoral head and acetabular impaction poses a high risk for developing debilitating secondary OA. For patients who develop post traumatic OA after an operatively treated acetabular fracture, total hip arthroplasty provides good symptomatic improvement.