Articular disimpaction in acetabular fractures

Acetabular impaction fractures when not adequately addressed leads to early arthritis. Dome impaction injuries and marginal impaction injuries have to be properly planned pre-operatively with respect to surgical approach, disimpaction techniques and fixation strategies. CT scan is the best modality to analyse the site, extent of impaction and plan strategies to reduce. Emphasis of early mobilisation should not drive the surgeon towards the motive of rigid fixation of columns alone, as the inadequate reduction of acetabular impaction leads to loss of mechanical support on weight bearing and thereby cause loss of reduction. Bone grafting either by auto or allograft or graft substitutes in the void after disimpaction helps in reducing anatomically and provide mechanical support adequately. In cases of severe comminution, reconstruction of the wall defect with autologous graft is a better treatment option. In this article we reviewed the characteristics of impaction injuries of acetabulum exploring surgical procedures, approaches and techniques for achieving open reduction and internal fixation.