Indications, techniques and complications in surgical treatment of the acetabulum

Almost 50 % of acetabular fractures occur in polytraumatized patients; in over 80 % additional injuries are found. The surgical goal is anatomical restoration of the acetabulum and stable fixation, in order to avoid postoperative external fixation.Careful clinical and radiological evaluation is essential to successful surgery. Standard radiological investigations include an anteroposterior view of the pelvis, a "spot" radiograph of the affected hip as well as obturator and iliac oblique views. The latter arc is especially helpful in assessing the central segment of the acetabulum ("dome fragment"). The documentation of any primarily traumatic sciatic nerve lesion is very important, and the quality of reduction depends greatly on the timing of surgery. The operation should be performed as early as possible after the surgical procedure has been carefully planned. A 3-D CT scan provides good information in choosing the surgical approach for complex fractures. In most cases, adequate reduction cannot be accomplished without appropriate aids. For internal fixation, both curved ASIF plates and straight plates are used. The operation demands a high degree of experience.Postoperative complications include iatrogenic nerve palsy, insufficient reduction, incorrectly placed implants, unstable fixation, redislocation, etc. With scrupulous aseptic conditions, the postoperative wound infection rate is low. Ectopic bone formation can occur after extensive surgical approaches and may, depending on size (Brooker III and IV), impair the range of motion of the hip. Indometacin given perioperatively is always indicated. Postoperative radiation treatment should as a rule be viewed critically.