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The cranial unstable transverse acetabulum fracture: an important variant
Lauren Luther1, Ridge Maxson1, R Brandon Ponce1
1Vanderbilt University Medical Center, Nashville, USA.
Summary
For combined pelvic ring and acetabulum fractures, a pelvis-first surgical approach leads to better reduction quality and less blood loss. This study compared pelvis-first versus acetabulum-first fixation in patients with transverse acetabulum fractures and posterior pelvic disruption.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Skeletal reconstruction
Background:
- Anatomic reduction of combined pelvic ring and acetabular fractures is crucial for optimal patient outcomes.
- Transverse acetabular fractures with ipsilateral sacroiliac joint instability represent a common and challenging injury pattern.
- The optimal surgical sequence for fixation in these complex injuries remains debated.
Purpose of the Study:
- To evaluate the impact of operative sequence on outcomes for transverse acetabulum fractures with concomitant posterior pelvic ring disruption.
- To compare the pelvis-first versus acetabulum-first fixation strategies in this specific patient cohort.
- To identify factors influencing reduction quality and clinical results.
Main Methods:
- A retrospective review of 24 patients with transverse variant acetabulum fractures and unstable posterior pelvic ring injuries over a 12-year period.
- Patients were divided into two groups: pelvis-first fixation (n=17) and acetabulum-first fixation (n=7).
- Data collected included demographics, injury mechanisms, associated injuries, operative details, and post-operative reduction quality.
Main Results:
- No significant differences in patient demographics or injury characteristics were observed between the groups.
- The pelvis-first approach was associated with a significantly lower rate of poor reduction quality (12% vs. 57%, P=0.038).
- Patients undergoing pelvis-first fixation experienced significantly less blood loss (500 mL vs. 1000 mL, P=0.009).
Conclusions:
- A pelvis-first surgical approach is associated with superior reduction quality in managing transverse acetabulum fractures with cranial unstable posterior pelvic fragments.
- The pelvis-first strategy may lead to reduced intraoperative blood loss compared to an acetabulum-first approach.
- These findings suggest that prioritizing pelvic fixation may optimize outcomes in this complex injury pattern.
Keywords:
Acetabular fractureAnterior–posterior compressionCombined injuryPelvic fractureTransverse acetabulum fractureMore Related Videos
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