Incidence of the Acetabuar Fracture

In AL-Thawra Modern general hospital

During 2009 –Sana'a-Yemen

الله. عبد سعيد دبامشموس

مقبل. صالح دالفيصلي

Ant. View of ACETABULAM

Post. View of ACETABULAM

.Callisen in 1788 start to said and to have reported the case of an acetabular fracture

During 2009

7070 patientspatients withwith

acetabular acetabular fracturesfractures

Gender Gender distribution of 70 distribution of 70 patients with acetabular patients with acetabular

fracturesfractures

14(20%)

56 cases(80%)

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The main cause of fracture is DISLUCATION OF THE HIP

● this injury is due to massive force transmitted along the femoral shaft, e.g. road traffic accidents or a back injury in someone kneeling.

distribution of 70 patients with distribution of 70 patients with acetabular fracture according acetabular fracture according

to to mechanismmechanism of injury of injury

MECHANISM OF TRAUMA

GENDER FEMALE

T%

RTA4057%GUN SHOT57%

FALLING2130%OTHER46%

TOTAL70100.00%

Type of Dislocation depends Type of Dislocation depends on on positionposition ::

I. Anterior dislocation of hipI. Anterior dislocation of hip

NON FRACTURE OF ACETABULAM

7-10%7-10% OF DISOF DIS

II. Posterior dislocationII. Posterior dislocation

Most common type of dislocationMost common type of dislocation..

Posterior rim is usually Posterior rim is usually fracturedfractured

Associated Associated sciatic nervesciatic nerve injury injury in 10%in 10%

flexed ,shortened ,adducted and internally rotated

III. CENTRAL dislocationIII. CENTRAL dislocation

Direct impact to the aspect of the hip through the acetabulum.

This is a fracture -dislocation.

Distribution of the acetabualr Distribution of the acetabualr fracture by fracture by age groupage group and and

gendergenderAGE

GROUPS

GENDERTOTAL

MFN%

19-2073107%

21-303674330.1%

31-40111128.4%

41-504132.1%

51-609296.3%

TOTAL561470100.00%

I. AP I. AP View View pelvispelvis

ACETABLUMFEMORAL HEAD

GREATERTROCHANTER

LESSER TROCHANTER

FEMORAL NECK

CORTICAL BONE

MEDULLARY BONE

FOVEA CAPITIS

II. JUDET viewOBTURATOR

(Internal oblique view)

III . JUDET viewIliac (exteternal oblique view)

WE CAN DIAGNOSEDTHE FRACTUREIN ONE OF 3 VIEW

CT is a very useful to CT is a very useful to assessment and planning of assessment and planning of surgerysurgery..

7070 patients with acetabular fracture patients with acetabular fracture accoding to accoding to associated injuresassociated injures

ASSOCIATED TRAUMATOTAL

N%

MULTIBLE TRAUMA2738%

ISOLATED ACETABULAR FRACTURE

4362%

TOTAL70100%

Distrubiton of acetabular fracture Distrubiton of acetabular fracture according to according to departementdepartement of intial of intial admissionadmission

DEPARTMENTGENDERTOTAL

MFT%

INTENSIVE CARE UNIT52710%

SURGICAL DEP.72912.8%

ORTHOPEDIC DEP.3584361.4

%NEUROSURGICAL DEP.4157%

UROLOGY DEP.5168.5%

TOTAL561470100%

associated injuryassociated injury

distribution of complication releated to distribution of complication releated to the associated injury in 27 patientsthe associated injury in 27 patients::

ASSOCIATED INJURIEN%

LIMBS622.2

VASCULAR316.2

NEUROLOGY211.6

UROLOGY933.3

ABOMINAL34.6

THORACIC42.3

TOTAL2738%

We used Letournel We used Letournel ANATOMICAL ANATOMICAL

system system classificationclassification

TYPE OF CLASSIFICATION

NO%

SIMPLE FRACTURE TYPE

posterior wall 2028%

posterior column34.2%

anterior wall11.4%

anterior column22.8%

transverse 710%

ASSOCIATED FRACTURE TYPE

posterior column +posterior wall11.4%

transverse +posterior wall1115.7%

T- shape57%

anterior column or wall + posteriorhemitransverase

811.4%

both column1217%

TreatmentTreatment

I. Closed reductionI. Closed reduction ( ( to reduce painto reduce pain) )

II. SURGICALII. SURGICAL

Closed reductionClosed reduction

Four Four methods of methods of closed reductionclosed reduction: :

1.

22 . .Allis Allis tractiontraction

3.

44. . ClassicalClassical

watson`s– jones methodwatson`s– jones method: :

Skin TractionSkin Traction

Skeletal tractionSkeletal traction

II. SURGICAL II. SURGICAL treatmenttreatment

should be considered forshould be considered for:: . .all displaced fractures of all displaced fractures of

the acetabulumthe acetabulum..

. .that do not meet the criteria that do not meet the criteria for nonoperative therapyfor nonoperative therapy..

Orthopaedic Orthopaedic Surgeon CanSurgeon CanGet You Back Get You Back

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