Fractures of the acetabulum: conservative treatment and results

The treatment of fractures of the acetabulum is still a controversial subject. There has in recent years been a tendency towards surgical rather than conservative treatment but more recently it has been observed that the long-term results of both types of treatment are not dissimilar. The classification of these fractures is important in relation to both conservative and surgical treatment. With the objective of rationalising the choice of treatment, 72 comminuted fractures of the acetabulum treated conservatively at the Orthopaedic Clinic in Perugia between 1959 and 1980 were reviewed. Both the clinical and radiographic features of these cases were analysed. The overall results were 70% successes and 30% failures. Several correlations indicating which features of the fracture had most influence on the final results were established; the involvement of the support surfaces (acetabular dome) and joint congruency were found to be the most important. In addition to these major factors, the age of the patient, presence or absence of dislocation, the degree of displacement and topography of the fragments collectively define the "type" of fracture and the criteria which are indispensable for the choice of treatment.