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SYMPOSIUM Table of Contents   
Year : 2002  |  Volume : 36  |  Issue : 1  |  Page : 27-28
Complex fractures of the acetabulum


LTM Medical College & Hospital, Mumbai, India

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How to cite this article:
Thakkar C J. Complex fractures of the acetabulum. Indian J Orthop 2002;36:27-8

How to cite this URL:
Thakkar C J. Complex fractures of the acetabulum. Indian J Orthop [serial online] 2002 [cited 2019 Oct 19];36:27-8. Available from: http://www.ijoonline.com/text.asp?2002/36/1/27/35921
According to Judet and Letournel's classification [1] , 3 or more part fractures of the acetabulum fall in the category of complex fractures. Accordingly the following fractures qualify to be called complex fractures

  • T shaped fractures
  • Posterior column + Posterior wall fractures
  • Transverse + Posterior fractures
  • Anterior wall / anterior column + Posterior hemi transverse fractures
  • Both column fractures


For successful management of complex fractures, it is essential that these fractures are analysed carefully with the available imaging modalities and various treatment options should be meticulously planned.

Using floppy lateral position on a regular table reconstruction of complex fractures becomes easier using ilio-inguinal approach for anterior column and Kocher Langenbeck approach for posterior component. [2],[3]

Presented below are examples of selected difficult cases.

Case 1:T Shape fracture : It is 3 fragment fracture of the innominate bone. Ilium, pubis and ischium are separated from each other. One can reduce and fix these fragments only through anterior approach, but if presented late, one may need two approaches to get the anatomical reduction [Figure 1]a,b,c.

Case 2: Central dislocation with fracture through the quadrilateral plate : This is one of the most difficult injuries to treat. Since one cannot approach quadrilateral plate directly, the fixation is indirect using a Buttress plate. [2] Ilio-inguinal approach was used. A T plate for lower end of radius was bent at 90 degrees just proximal to the distal most hole and was fixed to the pubis to act as a buttress plate [Figure 2(a)],[Figure 2(b)],[Figure 2(c)].

Case 3: Fracture through anterior column (high fracture), with separation of both anterior and posterior lips : A very unusual variety of fracture of anterior column. Through ilio-inguinal approach, the iliac wing was first temporarily fixed using K wires, through the most thin areas.[Figure 3]a,b,c.

Then it was fixed using one inter-fragmentary screw fragment was then reduced and fixed with one long inter fragmentary screw through the sciatic buttress. This screw is the key to fixation of the posterior column through anterior approach [Figure 4(a)],[Figure 4(b)],[Figure 4(c)],[Figure 4(d)],[Figure 4(e)].[4],[5]

 
   References Top

1.Letournel E. Fractures of the Acetabulum. In Elson RA (ed). Berlin; Springer-Verlag. 1993.  Back to cited text no. 1    
2.Moed BR, Carr SE, Watson JT. Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clin Orthop 2000; 377; 57-67.  Back to cited text no. 2    
3.Routt ML, Swiontkowski MF. Operative treatment of complex acetabular fractures: Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg [Am] 1990; 72-A:897.  Back to cited text no. 3    
4.Fica G, Cordova M, Guzman L, Schweitzer D. Open reduction and internal fixation of acetabular fractures. Int Orthop 1998; 22(6): 358- 351.  Back to cited text no. 4    
5.Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach : A 10 year perspective. Clin Orthop 1994; 305:10-19.  Back to cited text no. 5    

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Correspondence Address:
C J Thakkar
Advanced Orthopaedics Centre, Mukut, S.V.Road, Bandra, Mumbai 400 050
India
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Source of Support: None, Conflict of Interest: None


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    Figures

  [Figure 1], [Figure 2(a)], [Figure 2(b)], [Figure 2(c)], [Figure 3], [Figure 4(a)], [Figure 4(b)], [Figure 4(c)], [Figure 4(d)], [Figure 4(e)]



 

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