Surgical approach for reduction and internal fixation of central acetabular fractures

Abstract

INTRODUCTION IN central acetabular fractures it is important to achieve anatomical reduction, not only for a good functional recovery (Paleari and Gualtieri, 197 1) but also to provide good conditions for a later total replacement operation. In severe cases this is hardly possible with conservative treatment (Judet et al., 1964; Paleari and Gualtieri, 197 1; Batra, 1976). In addition, the results of treatment with conservative methods have been disappointing (Pearson and Hargadon, 1962; Eichenholtz and Starck, 1964; Batra, 1976). During the early history of total replacement operations for the hip joint, it became more and more evident that the strength and anatomical shape of the acetabulum after fractures are important for secondary procedures. Posterior fractures, simple fractures of the ilio-ischial column and posterior fracture-dislocations are easily treated by internal screw fixation (Rowe and Lowell, 1961). The management of central fractures which are mostly comminuted is more problematical. If conservative treatment fails (Dunn and Russo, 1973; Lansinger, 1977), operation is indicated (Judet et al., 1964; Mazas, 1969; De Lind van Winjngaarden and Wittebol, 1973). In these cases operative reduction and internal fixation necessitate a good surgical approach, which will be dealt with in this report on the basis of 16 cases treated by operation in our hospital between 1969 and 1974.