Tania Ferguson, Daren Forward
Acetabular fractures are articular fractures, so they should be treated under the principles of anatomical reduction, stable internal fixation, and early mobilization.
However, nonoperative treatment is relatively common for fractures in patients with increasing age and poorer quality bone.
It may represent an active choice for the start of a treatment strategy that includes a total hip replacement as a delayed procedure.
Indications for conservative treatment are:
Contraindications to nonoperative treatment, and thus indications for surgical treatment, are instability and incongruity.
Instability: Hip dislocation associated with:
Stability is determined by a roof arc measurement.
The roof arc angle is determined in the following way:
If the second line is outside of the fracture zone in each of the three radiographic views, the fracture is considered stable.
Our example shows a fractured weight bearing dome of the left acetabulum, with the second line well within the fracture zone, indicating instability.
These images show corresponding measurement of the roof arc on iliac oblique (left) and obturator oblique (right) views.
The joint would be considered incongruent if: