Fracture of the Acetabulum: Foundational Concepts
Acetabular fractures are intra-articular fractures of the socket of the hip, usually produced by high-energy trauma. They may be associated with hip dislocation, femoral head injury, pelvic-ring injury, neurovascular damage and major blood loss. The principal objectives of treatment are restoration of a congruent, stable and mobile hip; accurate reconstruction of the weight-bearing dome; and prevention of post-traumatic osteoarthritis, avascular necrosis and heterotopic ossification.
Relevant Anatomy and Biomechanics
The acetabulum is formed by the fusion of the ilium, ischium and pubis. Its superior weight-bearing portion is the acetabular dome or roof. The anterior and posterior columns are the major structural buttresses transmitting load from the femoral head to the pelvic ring. The quadrilateral surface is the thin medial wall of the acetabulum and is important in fractures with medial displacement of the femoral head.
The anterior column extends from the iliac crest or anterior superior iliac region through the anterior acetabular rim towards the superior pubic ramus. The posterior column extends from the greater sciatic notch through the posterior acetabulum to the ischial tuberosity. The posterior wall provides containment of the femoral head and is particularly vulnerable during posterior hip dislocation. Articular incongruity, loss…