Decision Making in Acetabulum Fractures – When to Operate and When Not to?

Abstract

The complexity of acetabulum fractures has always been challenging to the operating surgeon. In the past 50 years, following pioneering work by LeTournel and Judet, there is better clarity to the treating surgeon regarding the management of these fractures. 3D computerized tomography imaging has helped surgeons understand the fracture better andit remains the investigation of choice. Roof-arc angle measurements and the percentage of the fracture involving the superior dome are important determinants in deciding whether to operate or treat conservatively. Nonoperative management is mainly for undisplaced fractures and patients not fit for surgery. Fluoroscopy under anesthesia to check for hip joint stability and percutaneous screw fixation are new upcoming management modalities. The approaches described by LeTournel and Judet – Kocher-Langenbeck, Ilioinguinal, Iliofemoral, and extended Iliofemoral – remain the “gold standard” for appropriate fractures, but the availability of newer alternative approaches have expanded over time thereby facilitating surgeons to operate better. Keywords: Acetabulum fracture, 3D computerized tomography, roof-arc angle, Kocher-Langenbeck approach.