epidemiology and managment of acetabulum fracture by Dr.Akshat vijay.ppt

Acetabulum fracture in brief

2. Conclusions:
•Incidence of acetabular and pelvic fracture is increasing rapidly, especially in
the elderly, and a major increase can be expected by 2030.
•Treatment is increasingly surgical.
•Public health
 strategies need to be developed to reduce incidence and
improve treatment.

3. Conclusions:
•The incidence of pelvic and acetabular fractures increased markedly in Sweden
from 2001- 2016.
•Pelvic fractures were more common among females and acetabular among males.
•The surgical rate was higher for acetabular compared to pelvic fractures.
•Major gender differences in treatment choices were found with higher proportion
of men treated surgically for both fracture types, and in all age groups.

5. INCIDENCES of Acetabular Fractures
•Posterior wall- 26.8%
•Posterior Column- 4.5%
•Anterior Wall- 1.2%
•Anterior Column- 5%
•Transverse fracture- 7.5%
•T shaped- 7%
•Posterior wall with column- 3%
•Posterior wall with transverse fracture- 20%
•ACPHT- 7%
•ABC- 22%

9. Indications for CONSERVATIVE Treatment
On the basis of Roof arc measurement-
•A minimum of superior acetabulum is intact, as judged by roof-arc
measures of at least 45° on all three plain x-ray views (AP, obturator
oblique, and iliac oblique), or the CT subchondral arc is intact in the
superior 10 mm of the acetabulum.
•The femoral head maintains a congruent relationship with the intact
acetabulum on AP, obturator oblique, and iliac oblique x-rays, with all
three taken out of traction.
•There is no evidence of posterior hip instability.

10. Roof Arc Measurement
•The roof-arc angle describes the angle between a vertical line
beginning at the center of the femoral head and a line from this point
and the most superior displaced fracture line through the roof of the
acetabulum measured on AP, obturator oblique and iliac oblique x-
rays.
•Roof-arc measurements are not applicable to both column and
posterior wall fractures

13. Indications for CONSERVATIVE Treatment
On the basis of Dynamic stability-
•Range of motion was performed intraoperatively with image
intensification to assess for incongruity.
•The fracture to be treated operatively in case of or loss of congruence
or between the femoral head and acetabulum (also known as
subluxation) occurs during range of motion of the hip joint.
•With the patient under anesthesia, the hip was rotated externally and
internally in a flexed, extended, and abducted position.

14. Indications for CONSERVATIVE Treatment-
Posterior Wall fractures
•Fractures involving less than 20% of the posterior wall have been shown to be
stable, whereas fractures involving more than 40% of the posterior wall have
been shown to be unstable.
•Fractures involving between 20% and 40% of the posterior wall, for which
nonoperative treatment is being considered, should undergo a stress
examination under anesthesia to evaluate stability.

15. Indications for CONSERVATIVE Treatment-
•Roof Arc Measuremnets
•Femoral head congruent with superior acetabulum.
•Stress stability under anesthesia
•Fractures that include the acetabular fossa but not the articular
surface can also be treated nonoperatively
•Fractures with less than 2 mm displacement (essentially
nondisplaced) may also be appropriate for nonoperative treatment,
regardless of their location.

16. Indications for OPERATIVE Treatment-
•Significant displacement (≥ 2 mm) of the weight-bearing dome on any of
the three standard x-rays.
•Fractures judged to be unstable on image intensification stress
examination under anesthesia.
•Posterior wall fractures involving more than 40% of the posterior wall.
•Presence of incarcerated bone fragments in the joint resulting in hip joint
incongruence.
•Lack of secondary congruence or significant deformity in both-column
fractures.
•Displaced associated femoral head fractures.

17. •In 1980 Letronel demonstrated 80% good-to-excellent results in 492
hips.
•In 2012, Joel Matta demonstrated 79% survivorship in 816 patients
following surgical acetabular fixation (2–20 year follow-up).

18. PROGNOSTIC MARKERS for surgical outcomes
in Acetabulum fractures
•Age- Patients < 40 years of age had a better prognosis than their
older counterparts.
•Obesity- The authors demonstrated that patients with a BMI > 30
were 2.1 times more likely to have an estimated blood loss of > 750
cc and 2.6 times more likely to have DVT, while patients with a BMI >
40 were 5 times more likely to have wound infection.
•Poor fracture reduction (> 3 mm)
•Multi-fragmentary fractures of the posterior/ anterior wall

19. PROGNOSTIC MARKERS for surgical outcomes
in Acetabulum fractures
•Transverse multi-fragmentary fractures of the tectum.
•Marginal impaction
•Cartilage damage to the femoral head and/or acetabulum
•Delay to surgery > 5 days and > 15 days for associated and
elementary fractures patterns, respectively.
•Initial fracture displacement > 20 mm