Acetabular Injuries Research Articles

Rates of Prescription Opiate Use Before and After Injury in Patients with Orthopaedic Trauma and the Risk Factors for Prolonged Opiate Use

The prudent use of prescription opiate medications is a central aspect of postoperative pain management. The mortality associated with prescription opiate overdose is reaching epidemic proportions nationally, and is the leading cause of accidental death in greater than half the states in the United States. This study sought to determine the rates of preinjury opiate use in patients with orthopaedic trauma and the risk factors for prolonged use postinjury. The Utah Controlled Substance Database was queried to determine the use of prescription opiates by all patients admitted to the orthopaedic trauma service for a two-year period with isolated musculoskeletal injuries. Usage three months prior to injury and six months postinjury was examined. Six hundred and thirteen patients met inclusion criteria. Among patients with orthopaedic trauma, 15.5% had filled a prescription for opiates in the three months prior to injury, compared with 9.2% of the general population (p < 0.001). More than one prescription was filled by 12.2% of the patients with trauma preinjury compared with 6.4% of the general population (p < 0.001). Postoperatively, 68.4% of all patients filled opiate prescriptions for less than six weeks, 11.9% filled opiate prescriptions between six and twelve weeks, and 19.7% filled opiate prescriptions past twelve weeks. Patients with preinjury use of more than one opiate prescription in the three months preinjury were six times as likely to continue use past twelve weeks, and 3.5 times as likely to obtain opiates from a provider other than their surgeon (p < 0.001). Opiate use was briefest with upper-extremity injuries, followed by lower-extremity injuries and pelvic or acetabular injuries. Regression models demonstrate that risk factors for prolonged use of opiates include advancing age and extent of preinjury use. Patients with orthopaedic trauma are significantly more likely than the general population to use prescription opiates prior to injury. Preinjury opiate use is predictive of prolonged use postinjury and predictive of patients who will seek opiates from other providers.

Combined Pelvic Ring Disruption and Acetabular Fracture

Combined pelvic ring disruptions and acetabular fractures are thought to be uncommon. Our objectives were to characterize concomitant injury patterns and to compare them with historically observed rates for each injury in isolation. Retrospective review comparing a study group with historical controls. Fracture patterns were compared with our institution's isolated injury patterns and with isolated injury patterns of other published series. Level I academic medical center. Between 1997 and 2001, 854 pelvic ring disruptions and 457 acetabular fractures were evaluated. Forty patients sustained combined injuries. None. Fracture patterns, Injury Severity Scores, and mortality rates. Our series of combined injuries included 5% posterior wall fractures. This was significantly different from the 30% incidence of posterior wall fractures among isolated acetabular fractures at our institution (P < 0.006). No posterior column or posterior column with associated posterior wall fractures occurred. Fifty-three percent of the patients sustained anterior-posterior compression pelvic ring injuries, exceeding our center's 19% norm for isolated pelvic ring injuries (P < 0.001). For combined injuries, the mean injury severity score was 27.9 and the overall mortality rate was 13%. Early death occurred in 19% of patients with combined anterior-posterior compression injuries and 6% with lateral compression injuries. Patients with combined pelvic and acetabular injuries have multiple system injuries and high Injury Severity Scores. Fracture patterns differ from those observed with isolated injuries. Posterior acetabular fractures are uncommon components. Anterior-posterior compression pelvic injuries seem much more frequent in cases of combined injuries than isolated injuries and are associated with high mortality rates. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Acetabular Refracture Through Posterior Wall Malunion Treated with Sciatic Neuroplasty and Open Reduction and Internal Fixation.

Fractures involving the posterior wall are the most common type of acetabular fractures1-3. These injuries are often associated with posterior fracture-dislocations of the hip from high-energy trauma such as motor vehicle collisions4-6. Despite the frequency of these events, repeat acetabular injuries are exceedingly rare and, to our knowledge, have not been previously reported. We present two patients who sustained refracture through malunited, previously stable, nonoperatively treated acetabular fractures of the posterior wall. Challenges including malunited fracture fragment reduction and stabilization, sciatic neuroplasty, and posttraumatic nerve palsy in the setting of this uncommon clinical scenario are discussed. The patient from Case 1 and the patient and her parents from Case 2 were informed that data concerning the cases would be submitted for publication, and they all provided consent. Case 1. A forty-five-year-old man was involved in a motor vehicle collision that resulted in a fracture-dislocation of the left hip with a displaced, comminuted acetabular fracture of the posterior wall (Figs. 1-A and 1-B). Examination revealed a left foot drop with 0/5 ankle dorsiflexion and great toe extension strength, as well as numbness of the dorsal part of the foot. He was managed conservatively after evaluation under anesthesia revealed smooth, noncrepitant range of motion and stability at extremes of range of motion. At the six-month follow-up, the patient had regained antigravity function (3/5 strength) of the tibialis anterior and extensor hallucis longus muscles, with mildly improved sensation of the dorsal part of the foot. Hip stability was maintained despite radiographic evidence of a combined nonunion-malunion of the posterior wall of the acetabulum one year after the trauma (Fig. 2). Initial trauma radiograph (Fig. 1-A) and axial CT (Fig. 1-B) of the pelvis demonstrating a minimally displaced comminuted caudal acetabular fracture of the posterior wall (Case 1). Fig. 1-A Fig. 1-B Fig. 2 Follow-up radiograph one year after initial trauma with clinically stable hip despite nonunion-malunion of the acetabular fracture of the posterior wall (Case 1). …

Impact of road traffic "penalty points" on high energy pelvic trauma

Background:The penalty points system (PPS) was introduced in 2002 in an attempt to reduce the increasing rate of road traffic accident (RTA) related fatalities and serious injuries. Points are awarded based on the severity of the offence and are cumulative. A total of 12 points results in the disqualification from driving.Objective:A few studies have looked at the immediate or short term impact of PPS on trauma services or specific injuries such as spine trauma in Ireland. Little data is available on the long term effect of the PPS. The aim of this study is to see if the PPS system has had an influence on the number of pelvic injuries referred to our unit for surgical intervention and if this influence is sustained in the longer term.Materials and Methods:A retrospective review of all pelvic and acetabular injuries admitted to our unit from 1999 to 2008 was undertaken. The mechanism of injury, the site and patient demographics were noted.Results:A total of 467 patients were identified over the ten year period. 454 patients were included in the study. There was a significant male preponderance of 76%. Mean age was 36.5 years (range 16 to 83). RTA's were the cause in 74% (n = 335) of the cases. The annual work load remained similar over the years. There has been a reduction in the number of RTA related pelvic injuries. There have been notable drops in the number of these cases corresponding to the introduction of the PPS and its subsequent expansion. The number of pelvic injuries due to falls continues to rise.Conslusion:The introduction of the PPS and its subsequent expansion has had a positive influence on the number of RTA related pelvic trauma. Continued surveillance and enforcement of the PPS is important for a sustained benefit from it in the long term.

Optimized treatment of acetabular injuries

Optimized treatment of acetabular injuries

Results of treatment of intra-articular acetabular injuries

The influence of such factors as the term from the moment of injury to surgical intervention, the type of fracture according to the AO classification and a multiorgan injury on remote results of treatment of 162 patients with unstable fractures and dislocation fractures of the acetabulum was analysed. Better functional results were received in cases of intervention within 8-14 days after injury, whereas the used AO classification inadequately described the severity degree of the injury, which characterized these groups. It was found out that the better content of the treatment and more immediate its beginning, the better radioanatomical and functional results could be. The injury type and fracture type according to the AO classification were unreliable factors, which produced their effect on indices during 10 years after injury.

Thrombo-prophylaxis in pelvic and acetabular trauma patients: a UK consensus?

The incidence of deep vein thrombosis, non-fatal pulmonary embolism and fatal pulmonary embolism may be as high as 61%, 10% and 2%, respectively, in patients with pelvic and acetabular injuries. A survey of the pelvic and acetabular units across the United Kingdom was performed to ascertain the thrombo-prophylaxis policy for these patients. In particular, questions were asked about different regimes on post-operative patients, conservatively managed patients and those simply discussed over the telephone. We enquired about their known rates of DVT and PE and their methods of data collection. Postal questionnaires were sent to 22 pelvic and acetabular trauma centres around the United Kingdom. Replies from 18 units were received in which a total of 837 operations are performed per year. Forty-five percent of pelvic and acetabular units do not routinely prescribe chemical prophylaxis for post-operative patients and 56% do not prescribe prophylaxis for conservatively managed patients. The policy of the remaining units showed no consistency in duration or agent. Fifty-three percent of units use a database to collect information related to the numbers of patients operated up on. Forty-seven percent have no defined method for collecting DVT and PE numbers. For this reason, reported rates of proximal DVT, non-fatal PE and fatal PE were below that expected at 2.5%, 0.8% and 0.1%, respectively. Despite high rates of thrombo-embolic complications in patients with pelvic and acetabular injuries there is no UK consensus on prescribing prophylaxis.

Osteochondral impaction of the posterior acetabular surface without cortical fracture of any wall or column: an undescribed pattern of acetabular injury

Surgical treatment of a unusual acetabular fracture is described. This fracture was characterized by impaction and breaking down of the posterior articular surface and comminution of lamina quadrilatera lower portion, without cortical fracture of both columns. The fracture was treated surgically through the Kocher–Langenbeck approach. A small hole was created in the acetabulum posterior wall, the impacted fragment was reduced, and the bone defect was filled with autologous bone from the greater trochanter. A plate was shaped in order to fix both bone graft and fractured fragment.

Extrinsic compression of the external iliac artery following internal fixation of an acetabular fracture

Vascular injuries following fixation of acetabular injuries are becoming increasingly recognized. Most case reports describe thrombosis or rupture of the adjacent artery. Repair of these injuries is most often described by open technique with endovascular repair rarely reported. Here, we present a case of injury to the external iliac artery caused by extrinsic compression from orthopedic hardware following acetabular fracture repair. Diagnosis of this injury was difficult with angiography, but on duplex ultrasonography, the injury was more clearly seen. The injury was treated with endovascular angioplasty and stenting, with restoration of normal arterial flow to the lower extremity.

Verletzungen des Beckens

Kindliche Beckenverletzungen sind selten und werden auch heute noch nicht selten übersehen. Eine klar strukturierte Primärdiagnostik muss deshalb obligat durchgeführt werden, da auch instabile Verletzungen des kindlichen Beckenrings oftmals nur schwer zu diagnostizieren sind. Das Primär- und Definitivmanagement dieser Verletzungen orientiert sich im Wesentlichen an dem des Erwachsenen. Aufgrund der potenziellen negativen Langzeitfolgen sollte die Therapie der instabilen Beckenringverletzungen osteosynthetisch mittels kindadaptierter Stabilisierungstechniken erfolgen. Trotzdem muss mit Wachstumsstörungen gerechnet werden. Entsprechend sind regelmäßige klinisch-radiologische Kontrollen bis zum Abschluss des Wachstums zu fordern. Verletzungen der kindlichen Wachstumsfuge des Azetabulums sind schon aufgrund der schwierigen radiologischen Beurteilung selten. Entsprechend sind Angaben zur Inzidenz in der Literatur nicht einheitlich. Schwierigkeiten bestehen zusätzlich darin, bis zu welchem Alter das Azetabulum als „kindlich“ angesehen werden kann. Für die kindlichen Verletzungen hat sich die Klassifikation nach Salter-Harris bewährt. Die Mehrzahl dieser Verletzungen kann konservativ erfolgreich therapiert werden. Bei starker Dislokation oder intraartikulären Pathologien kommen auch offene Verfahren zur Anwendung. Aufgrund der Hauptgefahr der Ausbildung einer posttraumatischen Gelenkdysplasie sollten regelmäßige Kontrolluntersuchungen bis zum Wachstumsabschluss durchgeführt werden. Die Langzeitergebnisse können insgesamt als zufriedenstellend gewertet werden.

Osteopathic diagnosis of an acetabular injury.

Physical findings demarking pathologic somatovisceral reflex activity and fascial strain patterns may lead the osteopathic physician to diagnoses that are masked within the initial presentation of a patient. The authors present a case report that demonstrates the use of osteopathic principles in the diagnosis of a chronic acetabular fracture and acetabular labral tear in a 19-year-old man. The injuries resulted from a posterior hip dislocation sustained during a basketball game more than 1 year before presentation. Osteopathic manipulative treatment and diagnostic techniques also relieved the patient's persistent thoracic pain, nausea, and vomiting. Subsequent orthopedic repair had the potential to avert or delay degenerative hip disease in the patient.

Patterns of pelvic and acetabular injury among Sudanese patients.

Background: Most of major pelvic fractures result from very high energy trauma and require urgent hospital treatment. However more minor, stable fractures may only require a period of rest and analgesia followed by gradual mobilization. Extended civil development and increased means of transportation in Sudan during the last two decades led to an increase in the number of highly potentiated traumatic accidents including isolated or combined pelvic and acetabular injuries. For this reason a unit for pelvic surgery has been established in Khartoum north teaching hospital in 2006. Objectives: A prospective study designed to evaluate the various patterns of pelvic and acetabular injuries in Khartoum North Teaching Hospital. Material and Methods: Patients with pelvic ring and acetabular injuries treated in Khartoum North Teaching Hospital, Khartoum, Sudan, between August 2006 and September 2009 were enrolled in the study. The collected data had been managed statistically using the appropriate SPSS computer package. Results: Hundred ten patients were included in the study. There were eighty one males. The mean age (± SEM) was 36.6 ±1.61 years. The cause of injury was a road traffic accident in 89 patients, a fall from height in ten patients, a fall at home in three patients and in eight patients due to miscellaneous cause. Forty four (40%) patients presented directly to our hospital, whereas, 66 (60%) patients referred from other various hospitals from different region of Sudan. The average hospital stay (± SEM) was 16.12 ±1.09 days. Regarding pattern of fractures; pelvis only was 59.1%, acetabulum only was 25.5%, and combined pelvic and acetabular fracture was 15.5%. According to Tile’s classification of pelvic and acetabular injuries there were 25 (22.7%) patients with type C1 pelvis, 18 (16.4%) with type A2 pelvis, 15 (13.6%) with type A1 acetabulum, three 2.7% with type A2 pelvis and A1 acetabulum, and three 2.7% with type C1 pelvis & A3 acetabulum injuries. Thirty seven patients had associated skeletal fractures and 12 patients had extra-skeletal injuries. Conclusion: Pelvic and acetabular injuries remain relatively uncommon in Sudan when compared with other musculoskeletal injuries. But our study showed that there is a continuous increase in the number of pelvic and acetabular injuries. So, many pelvic surgery units are needed to be established to cover many areas in Sudan to overcome the delay factor which may affect management outcome. Keywords: Pelvic fracture; Acetabular fracture; Tile’s classification; AO group classification.

Superior gluteal artery injury presenting as delayed onset shock

Injury to the superior gluteal artery (SGA) is usually associated with acetabular fractures or posterior pelvic ring injuries. The diagnosis is suspected in cases of initial hemodynamic instability which is refractory to resuscitation. The initial presentation is often dramatic and is caused by direct injury to the artery at the time of traumatic impact. In these cases, patient management at most trauma centers follows a pre-arranged algorithm which decreases the likelihood of a missed diagnosis. Delayed arterial bleeding, however, is rare and potentially catastrophic since most algorithms are not designed to detect these infrequent occurrences. We present two such cases due to initial blunt buttock trauma combined with an anterior pelvic ring fracture and a L2 spine fracture which resulted in delayed massive bleeding from the SGA. Delayed arterial bleeding should be considered in late onset shock associated with pelvic or lumbar vertebrae body fractures or direct buttock injury. If active bleeding is suspected, urgent arteriography with embolization is the treatment of choice.

Femoroacetabular Impingement in Adolescents and Young Adults

Femoroacetabular impingement (FAI) is a recently described hip disorder resulting from an abnormal morphology between the proximal femur and acetabulum (socket). It is now recognized as a cause of hip pain in adolescents and young adults, and research has shown that it may also lead to early degenerative changes and osteoarthritis. Femoroacetabular impingement as a cause of precocious hip arthrosis was originally described by Ganz et al. in 2001, and a quick literature search on this topic will confirm that it has become a topic of cutting edge research within the orthopaedic community. The abnormal morphology in FAI results in increased hip contact forces with hip motion, especially flexion. This results in abnormal contact that can lead to acetabular labral tears and cartilaginous injury. Early diagnosis and treatment may possibly delay the future onset of hip arthritis. Although the precise cause of FAI is not well understood, the condition has become increasingly recognized as a cause of hip pain in active adolescents and young adults. The purpose of this article is to outline the history, physical examination and radiographic findings, and current conservative and surgical treatment modalities for FAI.

The Bristol regional pelvic and acetabular fracture service: Workload implications of managing the polytraumatised patient

Pelvic and acetabular injury may occur in isolation, or, in two-thirds of cases be associated with other significant injuries to the skeleton or other body systems. Most unstable pelvic and acetabular injuries require specialist surgical treatment which often means transfer to a specialist centre. The associated injuries also require assessment and treatment by appropriate specialists. It is believed patients treated in specialist centres for these injuries have an improved outcome. Costing implications therefore exist for hospitals purchasing such services from specialist pelvic units. This paper presents a review of the multidisciplinary specialty surgical workload generated by offering a regional pelvic and acetabular service in Bristol over a 1-year period. It suggests previous reports documenting the number of patients suffering pelvic and acetabular injuries associated with other significant injuries, may have been underestimated. This information informs health care purchasers of the real extent of the surgical and other services needed and the resources required to treat patients with unstable pelvic and acetabular injuries.

A Comparison of Optical and Electromagnetic Computer-Assisted Navigation Systems for Fluoroscopic Targeting

Freehand targeting using fluoroscopic guidance is routine for placement of interlocking screws associated with intramedullary nailing and for insertion of screws for reconstruction of pelvic and acetabular injuries. New technologies that use fluoroscopy with the assistance of computer guidance have the potential to improve accuracy and reduce radiation exposure to patient and surgeon. We sought to compare 2 fluoroscopic navigation tracking technologies, optical and electromagnetic versus standard freehand fluoroscopic targeting in a standardized model. Three experienced orthopaedic trauma surgeons placed 3.2-mm guide pins through test foam blocks that simulate cancellous bone. The entry site for each pin was within a circular (18-mm) entry zone. On the opposite surface of the test block (130-mm across), the target was a 1-mm-diameter radioopaque spherical ball marker. Each surgeon placed 10 pins using freehand targeting (control group) navigation using Medtronic iON StealthStation (Optical A), navigation using BrainLAB VectorVision (Optical B), or navigation using GE Medical Systems InstaTrak 3500 system (EM). Data were collected for accuracy (the distance from the exit site of the guidewire to the target spherical ball marker), fluoroscopy time (seconds), and total number of individual fluoroscopy images taken. The 2 optical systems and the electromagnetic system provided significantly improved accuracy compared to freehand technique. The average distance from the target was significantly (3.5 times) greater for controls (7.1 mm) than for each of the navigated systems (Optical A = 2.1 mm, Optical B = 1.9 mm EM = 2.4 mm; P < .05). Accuracy was similar for the 3 navigated systems, (P > 0.05). The ability to place guidewires in a 5-mm safe zone surrounding the target sphere was also significantly improved with the optical systems and the EM system (99% of wires in the safe zone) compared to controls (47% in the safe zone) (P < 0.002). Safe zone placement was similar among the 3 navigated systems (P > 0.05). Fluoroscopy time (seconds) and number of fluoroscopy images were similar among the three navigated groups (P > 0.05). Each of these parameters was significantly less when using the computer-guided systems than for freehand-unguided insertion (P < 0.01). Both optical and electromagnetic computer-assisted guidance systems have the potential to improve accuracy and reduce radiation use for freehand fluoroscopic targeting in orthopaedic surgery.

Broken Bones and Orthopedist Groans: Can an Acute Care Surgeon Fix Both?

Increasing reluctance of specialty surgeons to participate in trauma care has placed undue burden on orthopedic traumatologists at Level I trauma centers and prompted the exploration of an expanded role for general trauma surgeons in the initial management of select orthopedic injuries (OI) as an acute care surgeon. This study characterizes OI sustained by trauma patients (TPs) to analyze the feasibility of this concept. The National Trauma Data Bank was queried for specific information relating to the profile of OI. International Classification of Diseases-9th Revision codes were used to select patients for the study who sustained OI alone or in combination with other injuries as well as to determine body region of injury and a status of open or closed fractures. Skeletal Abbreviated Injury Scale scores were used to determine the severity of fractures, and International Classification of Diseases-9th Revision procedure codes were used to identify the nature of initial operative management. Of the 1,130,093 patients studied, 557,541 (49%) had one or more reported OI. Open injuries constituted 11.4% of all OIs and occurred in 7.5% of all TPs. Distribution of OIs was 23% upper extremity (18% open) and 35% lower extremity (also 18% open). These represent a 15% and 22% occurrence in TP. Pelvic and acetabular fractures occurred in 13% of OI patients (4% open) and 6% of all TP. The mean skeletal Abbreviated Injury Scale of all OIs was 2.3. For upper extremities it was 2.2, for lower extremities and for pelvic or acetabular injuries it was 2.4. Closed reduction of joint dislocation was performed in 2% of OI and 1% of all TPs. Of these, 45% were on the hip, 8% on the knee, 15% on the ankle, 13% on the elbow, and 20% on the shoulder. The distribution of initial interventions for all patients with OI was irrigation and debridement (I&D) 13%, external fixator (ex-fix) application 25%, closed reduction 41%, and closed joint relocation 10%. Of all open injuries, 17% underwent I&D and 31% underwent ex-fix application. The median time to I&D or ex-fix application was 7.2 hours. One percent of these procedures were performed within 1 hour of hospital admission, 11% within 6 hours of hospital admission. OI occur in a significant portion of TP reported to the National Trauma Data Bank. They most commonly involve the lower extremities and are of moderate severity. Given this profile, it seems feasible to propose that some initial procedures can be mastered by nonorthopedic surgeons and that select OI management be within the purview of a properly trained and credentialed acute care surgeon.

Management of Morel-Lavallee Lesion Associated with Pelvic and/or Acetabular Fractures.

Management of Morel-Lavallee soft tissue lesion (MLL) in patients with associated pelvic and/or acetabular fractures is still under discussion. Especially, the sequence of treatment of MLL soft tissue management and osteosynthesis of pelvic and acetabular injury remains controversial. We report all consecutive patients with MLL associated with pelvic ring and/or acetabular fractures during an 8-year period at our hospital. Surgical access and techniques were analyzed concerning complications and outcome. Altogether, 20 patients were included in the study. One patient was treated conservatively and MLL healed without complications; 19 patients had an operative treatment of MLL. In 15 patients debridement was performed within one day after injury and in four patients with delay of 5 days at least. Ten patients had surgery for an associated pelvic ring or acetabular fracture. In four of them MLL was operated before, in six patients simultaneously to osteosynthesis. In three patients, the same surgical approach for osteosynthesis and debridement of MLL was used; none of them showed postoperative complications. Altogether, in nine operated patients (47.4%) MLL healed without any complications. Nine operated patients presented prolonged wound healing, however, during long term follow-up, all patients showed complete healing of the MLL. One patient died during resuscitive surgical procedures. We recommend debridement for early and delayed treatment of MLL. Osteosynthesis during first debridement may be performed without adverse outcome. Identical surgical access for both procedures can be used. In case of repeated surgical debridement VAC(®) therapy may be a helpful tool for dead space reduction and wound conditioning.

Pelvic and acetabular surgery within Europe: The need for the co-ordination of treatment concepts

Pelvic and acetabular injuries are rare and represent the tip of the trauma iceberg. They often present with other associated injuries. Their management can pose difficulties even to the most experienced trauma surgeons and well-developed trauma systems. Despite the advancements made after the 1960s due to Judet and Letournel's contributions, the pelvic and acetabular sub-specialty has had difficulty in consolidating experience and developing realistic treatment protocols. By means of sharing ideas and results, "learning curves" of individuals and nations could be shortened. As a result, better health quality and advanced medical facilities for our future patients may be anticipated. In this article we examine the current problems affecting the provision of a high quality pelvic and acetabular service and analyse the needs for the co-ordination of treatment concepts within the European Landscape.

Acetabular fractures in the UK. What are the numbers?

We have established a nationwide directory of the specialist surgical units and their Lead Consultants with expertise in acetabular fracture surgery throughout the UK. Our directory has facilitated an estimation of the total numbers of operative acetabular fracture cases managed annually in the UK, as reported by those actually providing this specialist service. Previously the total number of acetabular injuries admitted and operated on in the UK was not known and there was no directory of acetabular surgeons in the UK. The introduction and accuracy of the OPCS codings will have massive financial implications for the DoH at a local and national level in the planning and provision of adequate health care resources. We have performed a questionnaire study to validate the DoH data for acetabular fracture surgery. Data was compiled using the ICD-10 for diagnosis of fracture of the acetabulum, and the OPCS-4 codes for the surgical procedures used for fracture fixation for the year 2003-2004. The Department of Health (DoH) data identified 44 units that had OPCS-4 coding for acetabular fracture fixation. We had a 95% (42 out of 44 units) response to our questionnaire. A total of 9 units contacted had actually performed no surgery, whereas the DoH coded these as having performed a maximum of 35 cases. The DoH data showed a total of 1825 admissions to 311 NHS hospitals for acetabular fractures, including 258 operative cases performed in 44 NHS hospitals in the UK. Our study has found that 748 acetabular fracture fixation cases were performed at 33 NHS hospitals in the UK in this study period. The total difference between the DoH operated cases and those confirmed by our study was 490. The hospital care for an operative acetabular fracture case may cost approximately 14,830, pounds if the actual numbers are under-reported to or by the DoH are 490, then approximately 7,266,700 pounds has been lost by these centres due to incorrect proportioning of resources.