![]() ![]() If the patient is unfit to undergo major surgery due to any reason, longitudinal traction to achieve secondary congruence of hip may help to restore hip function, though partially. The posterior injury may be tacked with anterior approach by experienced surgeon. The choice of approach rests with the surgeon, but going from front, or anterior approach is must. In this injury, non-operative treatment rarely gives satisfactory results. All three x-ray views plus CT scan is a must for diagnosis and management of this complex injury. Typically caused by a combination of forces acting on the hip though the femoral head. This type of injury has to be differentiated from both column fracture, where in the weight bearing dome is a floating piece not attached directly to bone forming sacro iliac joint Part of the weight bearing dome in this variety of fracture is still attached to that part of iliac wing which is forms part of sacro iliac joint. In this variety of fracture, the posterior or ilio ischial column is broken as a transverse fracture while the anterior or ilio pubic column is broken into multiple pieces. Depending on the location, the fractures are described as very low, low, intermediate and high anterior column fracture.Īnterior column + posterior hemi transverse This fracture is uncommon, typically occurring when the injuring force is applied from the side, against the greater trochanter of the femur bone, as in a fall on the side or being hit on the side. Occurs due to combined dash board injury and direct injury to the hip from the side. Antero posterior view may give clue to these injuries, Judet views and CT scan help in knowing the extent of injury. Posterior column with posterior wall fracture occurs due to dash board injury. Due to posterior wall fracture, the hip is usually dislocated posteriorly, requiring immediate reduction of dislocation and surgical reconstruction after few days. These fractures are rarely amenable to non-surgical treatment. With involvement of posterior wall, the difficulty in treatment increases. ![]() These fractures are extension of elementary fractures. The fracture is best seen in anteroposterior view and iliac and obturator oblique views.Īs with posterior wall injury, this also typically occurs due to dash board injury. This force may be combined with dashboard injury as well. This fracture typically occurs when the injuring force is applied from the side, against the greater trochanter of the femur, as in a fall on the side or being hit on the side. This fracture may be associated with a fracture through the posterior wall as well, making it more complex. Though both columns are broken, the weight bearing dome is still attached to the main part of the ilium and hence it is not a true fracture of both columns. Here the innominate bone is broken in such a way that all three parts of it, the ilium, the ischium and the pubis are separated from one another. When a transverse fracture also had a vertical fracture line, it is called a T shape fracture. The head of the femur is dislocated outside the joint. It typically occurs due to dashboard injury when a person travelling in a vehicle involved in a head-on collision, the force applied over the flexed knee travels along the femur bone to the head of the femur, breaking the posterior wall of the acetabulum. This is the most common variety of acetabular fracture. Judet-Letournel classification Elementary fracture They classified these fractures into elementary (simple two part) and associated (complex three or more part) fractures. In 1964, French surgeons Robertt Judet, Jean Judet, and Emile Letournel first described the mechanism, classification, and treatment of acetabular fracture. In older individuals or those with osteoporosis, a trivial fall may result in acetabular fracture. Together, the acetabulum and the head of the femur form the hip joint.įractures of the acetabulum in young individuals usually result from a high energy injury like vehicular accident or feet first fall. It is made up of three bones, the ilium, ischium, and pubis. The acetabulum is a cavity situated on the outer surface of the hip bone, also called the coxal bone or innominate bone. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur. ![]() Acetabular fracture as seen on plain X-rayįractures of the acetabulum occur when the head of the femur is driven into the pelvis. ![]()
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