Acetabulum management fracture surgery.ppt

fracture acetabular

1. Acetabulu
m
Theri Effendi
M Sadabaskara

2. Pendahuluan
•Acetabular fr relative uncommon
•Important cause major weight bearing
•Displacement > 3mm especially throught
the roof was consider to do open
reduction.

3. Anatomi
Anterior collum
Extend from Sympisis to iliac
crest
Posterior collum
Dense bone at the
greater sciatic notch
Superior dome
Great clinical significance,
unreduced cause
post traumatic artritis

4. Mechanism of injury
•Femoral head act as a
hammer
•Two basic mechanism of
injury
–Direct blow
–Indirect ( dashboard injury )
External rotated cause anterior
collum
Internal rotated cause posterior
collum
Abducted cause low tranverse
Adducted cause hight
tranverse

5. Radiological assesment

6. Radiological assesment

7. Radiological assesment

8. Classification
•Consists
–Anterior collum
–Posterior collum
–Anterior lip
–Posterior lip

9. Classification
•Letournel and Judet
–Simple
•Anterior collum
•Posterior collum
•Anterior lip
•Posterior lip
•Transverse
–Combine
•Posterior collum Posterior lip
•Anterior collum Anterior lip
•T fractures

11. Management
•Non operative
displace less 2mm
stable
•Operative
unstable
inconggruous
fr throught roof/dome
displaced dome fragment
T type
Both collum type
retained bone fr
displaced fr of femoral head
Soft tissue interpose

12. •Pre operative
–Antibiotika
–Blood
–Prophylaxis deep vein thrombosis
–Radiografic study

13. Approach
•Anterior
–Ilio femoral
–Ilio inguinal
•Posterior
–Posterior Kocher Langenbeck
–Posterior trantrochanteric
•Extensile
–Triradiate trans trochanteric
–Extended iliofemoral
–Combine

14. Approach
•Anterior
–Ilio femoral – for anterior collum

15. Approach
•Anterior
–Ilio inguinal

16. Approach
•Anterior
–Ilio inguinal

17. Approach
•Posterior
–Posterior Kocher Langenbeck
–straight lateral approach
–Modified Ollier

18. Approach
•Triradiate transtrochanteric approach

19. Approach
•Extended ilio femoral

22. Kocher - Langenbeck

24. Implant

25. Screw placement

26. Screw placement
•Danger zone

27. Complication
–Nerve injury
•Sciatic nerve
•Femoral nerve
•Superior gluteal nerve
•Lateral cutaneus nerve
–Infection
–Periarticular ectopic bone formation
–Thromboemboli
–Post traumatic arthritis (late)

28. Post operative care
•Bed rest
•Passive motion of the hip
•Gait training (4-7 days)
•Limited weight bearing (until 8 weeks)

29. Terima Kasih