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Acetabular Fracture

High-energy pelvic injury fracturing the hip socket, classified by Judet-Letournel system, requiring tailored operative or non-operative treatment based on displacement, congruence, and patient factors.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

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What is Acetabular Fracture?

The acetabulum is formed by the fusion of ilium, ischium, and pubis at the triradiate cartilage and consists of anterior column (iliopectineal line), posterior column (ilioischial line), anterior wall, posterior wall, dome, and quadrilateral surface. Fractures result from force vectors transmitted through the femoral head.

Judet-Letournel classification 5 elementary patterns (anterior wall, anterior column, posterior wall, posterior column, transverse) and 5 associated patterns (T-shaped, posterior column + posterior wall, transverse + posterior wall, anterior + posterior hemitransverse, both-column). Both-column is the only pattern with no remaining articular bone attached to the intact ilium.

Imaging: AP pelvis, Judet oblique views (45° iliac and obturator oblique), CT with 3D reconstruction (essential for surgical planning, identifies marginal impaction, fragment size, posterior wall comminution, dome involvement). Angiography for hemodynamic instability or penetrating wounds.

Symptoms

Severe hip and groin pain after high-energy trauma
Inability to bear weight
Hip held in flexion, internal rotation, and adduction (suggests posterior dislocation)
Limb shortening if associated dislocation
Sciatic nerve injury (foot drop) in 10–15% — often with posterior wall fractures
Hemodynamic instability with major pelvic disruption
Compartment syndrome of thigh in compressive injuries
Genitourinary injury (urethral, bladder) with associated pelvic ring fracture

Risk Factors

Motor vehicle collision (most common mechanism, dashboard injury)
Fall from height
Industrial crush injury
Bone fragility (osteoporosis, osteomalacia)
Pre-existing hip joint pathology
Younger patients (high-energy mechanisms)
Older patients with low-energy falls (anterior column or anterior wall patterns)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • All suspected acetabular fractures require trauma center evaluation
  • Hip dislocation after high-energy trauma — emergency reduction
  • Sciatic nerve deficit (foot drop) — urgent neurologic assessment
  • Vascular compromise of the limb
  • Open fracture with skin breach
  • Postoperative complications: heterotopic ossification, AVN, post-traumatic arthritis, sciatic nerve palsy

Treatment Methods

01
Initial management: ATLS protocol, hemodynamic resuscitation, pelvic binder if associated pelvic ring instability, urgent reduction of associated hip dislocation (closed reduction within 6 hours to minimize AVN risk), skeletal traction to maintain reduction and limb length
02
Imaging workup: full trauma series including AP pelvis, Judet views, CT with 3D reconstruction, vascular imaging if indicated
03
Indications for non-operative treatment: <2 mm displacement, hip joint congruent, patient unfit for surgery, low-demand elderly with isolated low-displacement fracture; protected weight-bearing 8–12 weeks, serial radiographs
04
Operative indications: >2 mm displacement, hip joint incongruent, posterior wall instability, marginal impaction, intra-articular fragment, irreducible dislocation
05
Surgical approaches: Kocher-Langenbeck (posterior column, posterior wall, transverse with posterior wall), ilioinguinal (anterior column, anterior wall, anterior column + posterior hemitransverse), modified Stoppa (anterior approach to quadrilateral surface, both-column), extended iliofemoral (rare, both-column with quadrilateral surface), combined approaches for complex patterns
06
Reduction techniques: Schanz screws in iliac crest and femoral head, ball-spike pushers, lobster claw forceps, plate provisional fixation; pelvic-specific instrumentation
07
Fixation: 3.5 mm reconstruction plates, lag screws, columnar plates; quadrilateral surface plate for medial buttress; periarticular screws avoid joint penetration (intraoperative fluoroscopy)
08
Acute total hip arthroplasty: indicated in elderly patients with severe comminution, marginal impaction, pre-existing arthritis; combined with ORIF or revision-style cup with augments and dual mobility
09
Postoperative protocol: prophylactic anticoagulation, indomethacin or radiation therapy for HO prophylaxis (especially with extensive surgical exposure), partial weight-bearing 6–12 weeks, progressive return to weight-bearing
10
Complications: heterotopic ossification (10–50% with Kocher-Langenbeck approach), avascular necrosis (5–10%), post-traumatic arthritis (20–40%, ultimately requiring THA in displaced fractures), sciatic nerve palsy, infection
11
Long-term: monitor for AVN with MRI 6 months, surveillance for arthritis with annual exam and radiographs, total hip arthroplasty for symptomatic post-traumatic arthritis (challenging due to altered acetabular anatomy and possible bone loss)

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.