Management Of Acetabular Fractures Research Articles

Rationales for the Bernese approaches in acetabular surgery

PurposeTo present two new approaches to acetabular surgery that were established in Berne, and which aim at enhanced visualization and anatomical reconstruction of acetabular fractures.MethodThe trochanteric flip osteotomy allows for surgical hip dislocation, and was introduced as a posterior approach for acetabular fracture management involving the posterior column and wall. For acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach is described.ResultsFull exposure of the hip joint, as provided by the trochanteric flip osteotomy, facilitates anatomical reduction of acetabular or femoral head fractures and safe positioning of the anterior column screw in transverse or T-shaped fractures. Additionally, the approach enables osteochondral transplantation as a salvage procedure for severe chondral femoral head damage and osteoplasty of an associated inadequate offset at the femoral head–neck junction. The Pararectus approach allows anatomical restoration with minimal access morbidity, and combines advantages of the ilioinguinal and modified Stoppa approaches.ConclusionsUtilization of the trochanteric flip osteotomy eases visualization of the superior aspect of the acetabulum, and enables the evaluation and treatment of chondral lesions of the femoral head or acetabulum and labral tears. Displaced fractures of the anterior column with a medialized quadrilateral plate can be addressed successfully through the Pararectus approach, in which surgical access is associated with minimal morbidity. However, long-term results following the two presented Bernese approaches are needed to confirm that in the treatment of complex acetabular fractures the rate of poor results in almost one-third of all cases (as currently yielded using traditional approaches) might be reduced by the utilization of the presented novel approaches.

End-stage Posttraumatic Osteoarthritis Treated With THA in Osteogenesis Imperfecta

Osteogenesis imperfecta is an incurable genetic disorder manifested with altered bone quality that predisposes patients to a multitude of fractures throughout their lives, including acetabular fractures. The management of acetabular fractures in patients with osteogenesis imperfecta remains a challenging clinical problem, with a paucity of literature supporting treatments and their outcomes. Limited reports in the literature validate the use of total hip arthroplasty (THA) in patients with osteogenesis imperfecta, and they describe the adult population only.This article describes a case of delayed diagnosis of a transverse acetabular fracture and femoral head impaction fracture that led to posttraumatic end-stage hip osteoarthritis in a 16-year-old boy with osteogenesis imperfecta (Sillence Type I) that was sustained after minimal trauma. Clinical examination 3 months postinjury revealed a significant pelvic obliquity, severe pain with hip range of motion, and limited hip range of motion. Imaging studies revealed a complete loss of articular cartilage and significant joint effusion.The patient underwent THA. No postoperative complications occurred. Two-year follow-up showed an excellent clinical result. The patient's hip was pain free, and he was able to walk with no limp.The authors are unaware of any reported cases of children with osteogenesis imperfecta undergoing THA. Based on the reported literature and the authors' experience, THA can be a reliable surgical option for patients with osteogenesis imperfecta.

Percutaneous Fixation of Geriatric Acetabular Fractures

The treatment of acetabular fractures in geriatric patients provides a unique set of challenges to the orthopaedic surgeon. Treatment strategies often differ from those employed to treat younger patients with acetabular fractures in order to minimize morbidity and mortality following these injuries. Treatment strategies to address these injuries include a repertoire of innovative methods for percutaneous or limited-open reduction and fixation in addition to traditional non-operative or open reduction and internal fixation methods. The purpose of this article is to discuss the challenges associated with the management of acetabular fractures in geriatric patients and to highlight current surgical techniques that can be applied to treat these patients.

Acute total hip replacement combined with open reduction internal fixation (ORIF) for the management of acetabular fracture in the elderly

The elderly patient with an acetabular fracture presents a unique surgical challenge because of medical comorbidities, decreased physiological reserve, reduced healing capacity, osteopenic bone, and atypical fracture patterns. Goals include rapid mobilization, early weight bearing, and a pain-free functional hip. Treatment options include initial nonoperative management with delayed total hip arthroplasty (THA), open reduction and internal fixation (ORIF), minimally invasive osteosynthesis, and acute total hip replacement combined with ORIF. Advantages of acute THA combined with ORIF in the elderly patient include the potential for 1-stage treatment with faster recovery and the avoidance of problems that can occur with delayed arthroplasty. Disadvantages include major technical challenges of simultaneously obtaining both implant and fracture stability. This review discusses the indications, contraindications, technique, and results of acute THA combined with ORIF for the management of acetabular fractures in the elderly. The technique for combined surgical treatment of an associated posterior wall/posterior column acetabular fracture with an ipsilateral femoral neck fracture is described.

Changes in the treatment of acetabular fractures over 15 years: Analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU)

Epidemiological, clinical and radiological data of 1266 patients with a unilateral acetabular fracture of up to 29 hospitals was reviewed. Three time periods, 1991–1993 (Registry I; n = 359), 1998–2000 (Registry II; n = 503), and 2005–2006 (Registry III; n = 404) were compared with regard to injury pattern and severity, fracture type, and chosen nonoperative vs. operative treatment to elucidate changes over time in the treatment of acetabular fractures. In the operatively treated group, time to operation, surgical approach, fracture fixation implants and fracture reduction quality were examined. 641 (50.6%) patients with isolated acetabular fractures, 410 (32.4%) multiple injured and 215 (17.0%) polytrauma patients with 642 (50.7%) simple and 624 (49.3%) associated acetabular fractures were evaluated. In the time period from 1991 to 2006, the rate of operative treatments increased nationwide to 77% ( ρ < 0.001). The distribution of fracture types involving the anterior and posterior wall changed with age ( ρ < 0.001). Across all registries, 583 (68.0%) operations were performed within 7 days, 212 (24.7%) operations between 7 and 14 days and 54 (6.3%) operations were performed later than 14 days after injury. An anatomical reduction (0–1 mm displacement) was achieved in 551 (64%) acetabular fractures. The obtained reduction quality did not correlate with time to operation, was lower in associated than in simple fracture types, and also lower in patients with isolated acetabular fractures than in polytrauma patients. Most importantly, the fracture reduction quality did not improve over time despite a higher frequency of surgical interventions. The Kocher–Langenbeck approach was preferred in the nineties in nearly three quarters of all operative procedures. Currently, the Kocher–Langenbeck and the ilioinguinal approaches are used equally often. The fracture fixation did not change over time and is achieved in 51% with plates in combination with single screws. This multisurgeon series illustrates a nationwide performance in acetabular fracture management. Despite changes in the chosen approaches and an increased surgical frequency, the operative treatment of acetabular fractures of the last 15 years did not lead to an increased reduction quality. Therefore, the rarity and complexity of acetabular fractures demands further specific teaching by experienced acetabular surgeons, scientific research and clinical outcome evaluation.

The Combined Hip Procedure: Open Reduction Internal Fixation Combined With Total Hip Arthroplasty for the Management of Acetabular Fractures in the Elderly

The objective of this study was to evaluate acetabular fractures in elderly patients treated with open reduction internal fixation combined with acute total hip arthroplasty during the same anesthetic. The authors conducted a retrospective analysis of a treatment. Level I and Level II trauma centers. Between September 1995 through January 2005, 22 elderly patients were treated using the combined hip procedure. There were nine transverse/posterior wall patterns, seven anterior column/posterior hemitransverse patterns, and six presented as a both column injury. Six patients had hip dislocations and 14 patients demonstrated some impaction. Patients underwent medical evaluations and clearance before surgical intervention. Standard open reduction internal fixation techniques followed by immediate total hip arthroplasty during the same anesthesia. Ilioinguinal patients were repositioned and redraped for total hip placement. Complications, physical examinations, and Harris hip scores assessed outcomes. Radiographs evaluated union and stability of the femoral and acetabular components, osteolysis, or the development of any heterotopic bone. Follow up averaged 29.4 months. Surgeries averaged 232 minutes with 1163 mL average blood loss. Hospital stays approximated 8 days with full weightbearing occurring at 3 months. Hip motion averaged 102 degrees of flexion, 32 degrees of abduction, and 16 degrees of adduction. Harris hip scores averaged 74. Four patients developed heterotopic ossification, and five underwent revisions as result of osteolysis or multiple hip dislocations. The combined hip procedure is an option for acetabular fractures in elderly patients. Complications, surgical times, and hospitalizations are consistent with open reductions or belated total hip arthroplasties. Aggressive medical workups may be needed, but a single posterior surgical procedure will avoid the "wait-and-see" approach often used for these patients.

Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China

Displaced acetabular fractures should be treated surgically. Over the past decade, surgical approaches to the acetabulum and the surgical technique for repair of common fracture patterns have advanced. Excellent outcomes after repair of these injuries can be achieved. The aim of this study was to assess the medium-term results of reconstruction of acetabular fractures by using shape-memory alloy designed by the authors. This is a retrospective review conducted at a level 1 trauma centre. From October 1999 to July 2009, 19 patients with acetabular fractures were treated with our patented Ni-Ti shape-memory alloy acetabular tridimensional memory alloy-fixation system (ATMFS). The ATMFS device was cooled with ice before implantation and then warmed to 40-50°C after implantation to produce balanced axial and compression forces that would stabilise the fracture three dimensionally. Our results are as follows; according to the D'Aubigne-Postel scoring system: Fifteen cases out of 19 (79%) achieved excellent or good clinical results. In two patients, late complications included avascular necrosis of the femoral head (ANFH) associated with posterior dislocation of the hip joint two years after the operation. We also observed two cases of grade II or III ectopic ossification, with good hip function, and one case of traumatic arthritis. In conclusion, these results demonstrate the effectiveness of the ATMFS device for the management of acetabular fracture. The device provides continuous compression of the fracture with minimal disruption to the local blood supply.

Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures

To assess the efficacy and safety of digastric trochanteric flip osteotomy technique in the management of acetabular fractures and to evaluate surgical outcome in terms of fracture reduction, femoral head viability of selected acetabular fractures treated operatively using a digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with surgical dislocation of the femoral head. Prospective. Eighteen patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures. OUTCOME EVALUATION: Clinical and radiographic analysis after a minimum 18 months follow-up. Methods A single modified approach involving digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with anterior (n = 14) or posterior (n = 4) surgical dislocation of the femoral head, was done for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement. At a mean follow-up of 26 months (18–40 months), the 17 patients presented with a good to excellent clinical result according to the d’Aubigné score. In all subjects, anatomical reduction was achieved during surgery. The osteotomy site healed at an average of 7 weeks and all the patients recovered abductor strength at 12 weeks. One avascular necrosis occurred in a case of posterior column plus wall fracture (who presented to us after 3 weeks). No heterotopic ossification interfering with hip function was found. This technique gives good exposure (especially in posterior wall, dome area, posterior fracture-dislocation with intra-articular fragments/femoral head fractures and T-fractures), preservation of abductor strength (which may be lost with excessive retraction of abductors to see dome area in classical posterior approach), reliable healing of osteotomy (in contrast to conventional trochanteric osteotomy) without risking the vascularity of femoral head.

OPERATIVE TREATMENT OF TRANSVERSE ACETABULAR FRACTURES: IS IT REALLY NECESSARY TO FIX BOTH COLUMNS?

we prospectively evaluated clinical and radiographic outcomes in patients with displaced combined transverse-posterior wall acetabular fractures managed at our Institution over a period of seven years by posterolateral single approach, direct posterior wall and posterior column reduction and plating, and indirect reduction of anterior column controlled by fluoroscopic images with or without lag-screw fixation. The aim was to identify if the obtained immediate postoperative Matta radiographic roof-arc angles after fracture reduction and fixation alters in the postoperative period when comparing posterior plating alone versus posterior plate and anterior column lag-screw fixation. 35 skeletally mature patients (31 male and four female, with mean age of 39.9 years old [range, 23.3 to 66.7 y/o]) with combined transverse-posterior wall acetabular fractures surgically treated by a posterolateral single approach were enrolled in this prospective investigation. Nineteen patients had associated orthopaedic injuries. The first part of the acetabular fracture management was similar to all patients and consisted in anatomical reduction and fixation of the transverse posterior component followed by anatomical reduction and fixation of the posterior wall component. The transverse anterior component reduction was controlled by fluoroscopic images (anteroposterior (AP), iliac oblique, and obturator oblique views) and digital palpation through the greater sciatic notch. Fifteen of the 35 patients had an additional lag-screw fixation from the posterior to the anterior columns with an extra-long small-fragment cortical screw. AP and Judet oblique radiographic views were taken at the end of the procedure and roof-arc angles were measured. Clinical results were assigned according to the grading system of Merle D'Aubigne and Postel as modified by Matta et al. Radiographic roof-arc angles were checked and compared between the two groups of patients to the same data collected both at the time of the surgical procedure and at three months postoperatively. Statistical analysis was done by either using chi-square (clinical outcome) and Mann-Whitney (roentgenographic outcome) tests, with a level of significance of alpha = 5%. at final follow-up examination 18 to 84 months postoperatively (mean, 46.8 months), the clinical results were considered satisfactory in 31 (88.6%) patients (excellent in nine (25.7%) and good in 22 (62.9%) patients). There was no difference between patients with (n = 15) and without (n = 20) fixation of the transverse anterior component of the acetabular fracture (p = 0.67). Radiographic roof-arc angles measured at discharge, at three months postoperatively and at the last follow-up consultation didn't changed significantly (p > 0.05). There was no statistically significant difference between patients treated with (n = 15) and without (n = 20) fixation of the anterior component of the transverse acetabular fracture in terms of medial displacement of the femoral head. the authors suggest that associated transverse-posterior wall acetabular fractures can be managed by a single posterior approach. Direct reduction and fixation of the posterior wall and column components is an adequate option for these injuries. If there is adequate indirect reduction of the anterior column, as checked by digital palpation and fluoroscopy, we feel that it is not necessary to fix the anterior column component of the transverse acetabular fracture.

Total Hip Arthroplasty for Post-Traumatic Arthritis After Previous Acetabular Fractures

Management of acetabular fractures has continued to evolve and improve since Letournel first reported results of open reduction and internal fixation of such fractures nearly three decades ago. There has been much improvement in the surgical techniques of anatomic reduction and rigid internal fixation of displaced acetabular fractures.

Operative management of acetabular fractures: a retrospective analysis of 46 cases

Objective To discuss our experience of diagnosing and treating acetabular frac-tures. Methods From January 1999 to December 2006, a total of 48 acetabular fractures in 46 patients were treated surgically, including 18 hips of Type A, 22 hips of Type B, and 8 hips of Type C. Ilioinguinal approach was adopted in 6 hips, Kocher-Langenbeck approach in 27 hips, combined an-terior and posterior approach (Ilioinguinal plus Kocher-Langenbeck) in 13 hips, and extended iliofemoral approach in 2 hips. Results Anatomical reduction was obtained in 32 hips (66.7%), satisfactory reduction in 11 hips (22.9%) and poor reduction in 5 hips(10.4% ). All the cases were followed up for 4 months to 4 years, with an average of 29 months. They were evaluated according to D'Aubigne and Postel criteria for joint functions. Twenty-six hips were rated as excellent, 9 hips as fine, 9 hips as fair and 4hips as poor. The good-excellent rate was 72.9%. Conclusions CT three-dimensional reconstruction is a great help for a doctor to make accurate diagnosis of the type of complex acetabular fractures and thus select an appropriate operative approach. Preoperative simulation in vitro on a pelvic specimen also helps a doctor reduce operative time and improve operative rcsuhs. Maximal anatomical reduction and good internal fixation are es-sential for satisfactory outcome. Key words: Acetabular; Fractures; Fracture fixation,internal

External iliac artery thrombosis associated with the ilio-inguinal approach in the management of acetabular fractures: a case report

IntroductionThe ilio-inguinal approach has come to be used routinely in the management of acetabular fractures involving the anterior wall. Thrombotic complications following surgery via this route are a serious, but rare, complication.Case presentationWe report the case of a 66-year-old male patient who slipped on an icy pavement and fell on his left hip. He sustained a comminuted acetabular fracture (a transtectal T-fracture with an incomplete posterior stem through the ischial tuberosity), and was operated on five days later, via an ilio-inguinal approach. In the recovery room, his left lower limb was found to be cool and pale. Immediate re-exploration showed a left external iliac artery thrombosis, and thrombectomy was performed. In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury) and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented.ConclusionWe recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.

Evidence for early surgery in the operative management of acetabular fractures

Evidence for early surgery in the operative management of acetabular fractures

Evidence for early surgery in the operative management of acetabular fractures

Purpose: The purpose of the study was to ascertain whether there were benefits from surgical treatment of acetabular fractures within 3 days of injury, as opposed to within a 2–3 week time period as stated in the current literature. Method and subjects: This is a matched-pair, retrospective study, using prospectively entered data from two trauma units’ databases, of patients with acetabular fractures treated operatively between 1991 and 1996. Patients were matched for age, acetabular fracture pattern and associated injuries. One group of patients had surgery within 3 days of injury (median time to surgery 1.5 days), the other group had surgery at 4 or more days post-injury (median 8 days, range 4–19 days). There were 128 patients, 64 per group. Results: The proportion of patients with complications was higher in the later surgery group (relative risk 2.1, CI 0.24–0.87). Median lengths of stay were significantly shorter in the early surgery group, 11 days compared to 22 days (p < 0.001 Mann–Whitney U test). The rate of HO in the early surgery group was 2% compared with 14% in the later surgery group. The rate of good or excellent results was 81% in patients with earlier surgery, and 72% in the later surgery group, in those with median follow-up time of 24 months. Conclusions: Surgery for acetabular fractures can and should be undertaken as soon as possible. In the setting of our Trauma Units, this seems to confer lower risks of early and late complications, shorter in-patient stay and may improve long-term outcome. "Abstracts from the 2005 Meeting of the British Trauma Society, held jointly with the Hellenic Association of Orthopaedic Surgery and Traumatology"InjuryVol. 38Issue 1Preview Full-Text PDF

Management of Acetabular Fractures in the Elderly Patient

Operative management of displaced acetabular fractures yields better results than nonoperative management. Over the past decade, surgical approaches to the acetabulum and the surgical tactic for repair of common fracture patterns have been advanced. Excellent outcomes after repair of these injuries can be achieved. In some cases, as in the elderly, or in those cases in which there is significant destruction of the articular cartilage, primary total hip arthroplasty may provide the best solution. Removal of the femoral head allows for excellent exposure of the acetabulum, making it possible to stabilize most fractures without the need for extensile or intrapelvic approaches. The surgical technique that has been successfully used calls for gaining primary stability of the acetabular columns by open reduction and internal fixation and then using the acetabular component to replace the articular surface. The columns need not be anatomically reduced. Multiholed acetabular shells can be used as internal fixation devices by placing screws into the columns enhancing the stability of the repair. In older individuals with severe osteoporosis, a typical fracture pattern results in intrapelvic dislocation of the femoral head with a blowout fracture of the anterior column and medial wall. Reinforcement rings with cemented acetabular fixation can be used in these cases. The femoral head can be used as bulk bone graft to replace and reinforce the reconstruction. Techniques common to revision of failed acetabular components are helpful in this setting. The results of reconstruction of severe acetabular fractures with total hip replacement have been reported to be similar to those achieved for reconstruction of osteoarthritis.

Operative management of acetabular fractures: A review of 73 fractures

Between June 1994 and December 2000, 80 displaced acetabular fractures were treated by open reduction and internal fixation, where possible by a single surgical approach. We report our results in 72 patients (73 fractures) who completed a minimum follow-up of 2 years. The average age of patients was 39.5 years (range 15-76 years). Thirty-four fractures were classified as simple and the remaining 39 were complex fractures. Twenty-four patients were recorded to have posterior dislocation of the hip joint at the time of initial presentation and at surgery eight patients were noted to have varying degrees of damage to the head of the femur. The average time to surgery was 11.7 days (range 1-35 days); 80% of cases were operated within 2 weeks period. The average follow-up was 45.5 months (range 24-96 months). In 67 fractures (92%), only a single approach was used (Anterior Ilioinguinal 26 cases; Posterior Kocker-Lagenbach 41 cases). Five fractures needed an extensile triradiate approach and only one case required a combined anterior and posterior approach. Congruent reduction was achieved in 89% of cases. Main complications included deep infection in two patients (2.7%) and severe degenerative changes in three patients (4.2%). A total of four patients (5.5%) required a total hip replacement. There were no cases of deep vein thrombosis or pulmonary embolism. Heterotopic ossification grade III was seen in three (4.1%) cases and none were grade IV. At the latest follow-up the average Harris hip score was 85 (range 20-100). We conclude that in the majority of cases internal fixation is possible through a single approach provided patients are referred early to a specialist unit. This results in satisfactory outcome with reduced morbidity and complication rate.

Operative management of acetabular fractures in Oxford

We reviewed the epidemiology and complications of 79 patients who had operative treatment for an acetabular fracture undertaken at this hospital, in the first 5 years of a pelvic and acetabular fracture service. The median Injury Severity Score was 18 (range, 9–41). Sixty-five patients (82%) had an important injury of at least one other system. Eighteen patients (23%) had a sciatic nerve injury on presentation. Thirty-seven patients (47%) had a post-operative complication, but this did not affect the outcome in the majority. The re-operation rate was 5%. Seventy-four patients (94%) had clinical and radiological follow-up for a mean of 2.6 years. Fifty-five patients (74%) had a good or excellent result, which was associated with early operation and an anatomical reduction. Poor outcome was associated with delay to surgery, failure to achieve or maintain reduction, and femoral head damage at the time of injury.

Book Review

Master Cases: Orthpaedic Trauma. Clayton R. Perry and Charles M. Court-Brown, Thieme, New York, NY, U.S.A., 1999 The purpose of this book was to present a case-based approach to orthopaedic traumatology. The authors employ a collection of case presentations to provide an interactive format to examine critical issues surrounding trauma in both the upper and lower extremities. The use of a clinical case-based teaching format to illustrate basic principles and controversies in orthopaedic traumatology stands in marked contrast to conventional orthopaedic trauma textbooks. The authors carefully detail a representative cross-section of orthopaedic trauma experience. The material examined ranges from simple to complex, but is not all-inclusive. The book is organized in two principle sections. Section I examines upper extremity fractures (25 cases) and section II lower extremity injuries (39 cases). Each chapter is organized as if a patient were presenting to an emergency room: history and physical examination, radiographic findings, diagnosis, surgical management, and postoperative management. Three sections follow each case presentation: discussion, alternative methods of management, and complications. Each alternative management of a given fracture is displayed in a table format highlighting its advantages and disadvantages and a brief comment about each technique. Last, the authors provide suggested readings for each clinical scenario. This format challenges the reader to think critically about each patient's case and problem in a sequential fashion. The reader is presented with the history and clinical findings and has the opportunity to interpret the radiographs. The reader can formulate a potential treatment plan, and as the discussion unfolds, the reader will learn if it is one of the methods proposed by the authors. The authors often provide clinical pearls and pitfalls based on their voluminous experience as internationally known traumatologists. The authors do not emphasize particular instrumentation choices but examine the key anatomic, technical, and fundamental patient management issues. Decision points are emphasized. Is the distal humerus fracture intra-articular? Does one need to use an olecranon osteotomy or two-incision approach? What features shape these decisions? These are representative issues that are addressed. Throughout the text, the authors emphasize the need to look not only at the osseous injuries, but to consider the complete management of the patient's injury patterns. The author's stress the importance of the soft tissue injury, need for debridements, timing of interventions, and consideration of ultimate patient function. Naturally, criticism of case-based textbooks will stem from the author's lack of coverage of particular injury patterns or those not covered in enough detail. The lack of coverage of acetabular fractures and sole case of a pelvic injury represent a shortcoming of this text. Acetabular fracture management seems uniquely suited to this type of format. These fractures often confuse orthopaedic surgery residents and the general orthopaedist. Other injury patterns that merit more attention are knee dislocations or fracture/dislocations. In summary, this text is a valuable addition to the libraries of most orthopaedic residents and general orthopaedists. It will provide a useful starting ground to stimulate further discussion of the numerous controversies that surround orthopaedic trauma management. However, the more experienced reader will want to supplement this text with more recent, comprehensive and in depth studies and reviews of the respective injury types. This book, however, represents a refreshing case based format to examine the complex field of orthopaedic traumatology.

Management of Acetabular Fracture

Acetabular fractures are relatively uncommon, but frequency is becoming increasingly with the increase of automobile accident. Undisplaced acetabular fractures have a good prognosis, but major displaced acetabular fractures have always given rise to difficulty and have a problem if fractures are not accurately evaluated, classified and reduced anatomically. The priciples of treatment are to restore the fractured acetabulm to its normal anatomy, to maintain and restore the function and accordingly early joint motion to promote healing and to prevent joint adhesion. However, the treatment of displaced fracture of acetabulum has been controversal. Judet, Pennal and Matta advocated open reduction and internal fixation for displaced fracture of acetavbulum. But, Watson Jones and Crenshaw reported that closed reduciton such as traction was used, good result could be obtained. The authors studied the sex and age distribution, classification according to roentgenographic findings, associated injuries, methods of treatment and prognosis among 67 patients who were admitted to the department of Orthopedic Sugery of Chonbuk National University Hospital under diagnosis of acetabular fracture and we evaluate the usefulness of spring plate for posterior wall fracture of acetabulum. 대한골절학회지 제12권, 제1호, 1 9 9 9년 1월 The Journal of the Korean Society of Fractures Vol.12, No.1, January, 1999

Non-operative management of acetabular fractures. The use of dynamic stress views.

To assess the stability of the hip after acetabular fracture, dynamic fluoroscopic stress views were taken of 41 acetabular fractures that met the criteria for non-operative management. These included roof arcs of 45 degrees, a subchondral CT arc of 10 mm, displacement of less than 50% of the posterior wall, and congruence on the AP and Judet views of the hip. There were three unstable hips which were treated by open reduction and internal fixation. The remaining 38 fractures were treated non-operatively with early mobilisation and delayed weight-bearing. At a mean follow-up of 2.7 years, the results were good or excellent in 91% of the cases. Three fair results were ascribed to the patients' other injuries. Dynamic stress views can identify subtle instability in patients who would normally be considered for non-operative treatment.