[Acetabulum fractures].

Abstract

Each acetabular fracture means a huge intellectual and a demanding technical challenge for the surgeon on charge. Because the hip joint is situated within a complex three-dimensional structure the diagnostics of its lesions are difficult. Three conventional X-ray views enable the recognition of a specific fracture type, computertomographic cuts give a detailed view on the type and the severity of the cartilage lesions, threedimensional reconstructions make a clear spatial imaging of the fracture configuration possible. These different radiological images are not superfluous, but complementary. Preoperative planning involves the choice of the approach and of the type of osteosynthesis. The Kocher-Langenbeck and the ilioinguinal approach are non-extensile approaches. They enable the internal fixation of the big majority of acute lesions. Each approach has its specific, well defined field of indications. Specific complications of the Kocher-Langenbeck approach are sciatic nerve palsy and periarticular ossifications. Complications of the ilioinguinal approach are damage to the iliac vessels and/or lymph vessels, to the lateral femoral cutaneous nerve and to the femoral nerve. Aseptic necrosis of the femoral head is a common complication of both approaches, but has to be differentiated from wear of the femoral head due to friction. Indications for the extended approaches are limited, their risks and complications are higher than in the non-extensile approaches. An active aftertreatment is only possible after a stable fracture fixation, the characteristics of physiotherapy are dependent on the type of approach. In a personal series of 225 operatively treated acetabular fractures, 128 were stabilized through a Kocher-Langenbeck approach. 103 of these patients could be reviewed after an average time of 25.9 months. 73.8% of them had an excellent or good result in the classification of Merle d'Aubigne. 61 fractures were fixed through an ilioinguinal approach. 48 could be reviewed after a mean time of 23 months. 85.4% obtained an excellent or good result in the functional scale of Merle d'Aubigne. These results are comparable with similar larger studies in the recent literature. The acetabular fracture in the elderly is a specific and rare type of lesion. When operated on quickly, open reduction and internal fixation can also give gratifying results. Alternative methods as primary or secondary total hip arthroplasty are at least as demanding for the patient and are combined with a high percentage of loosening of the acetabular component. The rarity and complexity of acetabular fractures asks for a specific teaching and learning with a experienced acetabular surgeon.