From the Research
The initial management for a left comminuted acetabulum fracture involves stabilization of the patient following trauma protocols, pain control with opioid analgesics, and skeletal traction using a distal femoral pin with 15-20 pounds of weight to maintain alignment and prevent further displacement. The patient should be kept non-weight bearing on the affected side and undergo urgent imaging including plain radiographs (AP pelvis, Judet views) and CT scan with 3D reconstruction to fully characterize the fracture pattern 1. Neurovascular status of the affected limb should be closely monitored, and DVT prophylaxis initiated with low molecular weight heparin (enoxaparin 40mg subcutaneously daily).
Key Considerations
- Consultation with orthopedic surgery, specifically a pelvic/acetabular specialist, should be obtained immediately as these complex fractures often require surgical fixation 2.
- Surgery is typically delayed 3-5 days to allow for soft tissue swelling to subside, but should not be delayed beyond 2 weeks as this can complicate reduction 3.
- Traction is necessary in the interim to prevent femoral head subluxation, muscle spasms, and further cartilage damage, which could lead to post-traumatic arthritis if alignment is not maintained.
Surgical Approach
- The choice of surgical approach depends on the fracture pattern, with the Kocher-Langenbeck and Ilioinguinal approaches being the most commonly used 1.
- The Anterior Intra-Pelvic approach has also become relatively common in recent years.
Complications and Outcomes
- Post-traumatic osteoarthritis remains a major complication of acetabular fractures, with 16.9% of cases developing Matta grade III/IV changes by 44 months 1.
- Heterotopic ossification is also a common problem, and functional outcomes after acetabular fracture appear to remain similar despite changes in patient population and surgical techniques over time 1.