Transverse

Transverse fractures are often displaced, requiring surgery. The higher the fracture, the more likely surgery will be required.

The approach used is dictated by the location of the maximum displacement, whether anterior or posterior. Typically, a posterior approach will be used. The Kocher-Langenbeck approach is satisfactory for most transverse fractures.

Thorough preoperative evaluation of the fracture will allow the majority of acetabular fractures to be managed through a single surgical approach.

Fracture reduction can be difficult and it is possible to reduce for example the posterior fracture apparently perfectly, but with significant anterior displacement remaining.

Some surgeons favor a sequential approach combining posterior and anterior approaches.

Surgery is urgent for irreducible dislocation and hip joint incongruity with risk of femoral head damage.

Transverse fractures are often displaced, requiring surgery. The higher the fracture, the more likely surgery will be required.

Thorough preoperative evaluation of the fracture will allow the majority of acetabular fractures to be managed through a single surgical approach.

Fracture reduction can be difficult and it is possible to reduce for example the posterior fracture apparently perfectly, but with significant anterior displacement remaining.

Some surgeons favor a sequential approach combining posterior and anterior approaches.

Surgery is urgent for irreducible dislocation and hip joint incongruity with risk of femoral head damage.

Decision making2

Skill level

Equipment

Main indications

Undisplaced fractures with a congruent hip joint, low infratectal fractures

The greater the roof arc angle, the more suitable the fracture for nonoperative treatment (roof arc angle >30° anteriorly, >45° in the mid zone, and >60° posteriorly).

Caution
Transtectal transverse fractures significantly involve the weight bearing articular surface, so that any displacement or gap may compromise outcome. Thus, surgical repair is more strongly indicated.

Advantages

Avoidance of risk of surgery

Undisplaced fractures with a congruent hip joint, low infratectal fractures

The greater the roof arc angle, the more suitable the fracture for nonoperative treatment (roof arc angle >30° anteriorly, >45° in the mid zone, and >60° posteriorly).

Advantages

Avoidance of risk of surgery

Skill level

Equipment

Main indications

Displacement of mainly the posterior portion

This approach can be enlarged with the trochanter osteotomy extension.

Advantages for approach

Easy manipulation of fracture fragments
Easy control of low fractures

Disadvantages

Heterotopic bone formation
Interference with subsequent hip replacement

Displacement of mainly the posterior portion

This approach can be enlarged with the trochanter osteotomy extension.

Advantages for approach

Easy manipulation of fracture fragments
Easy control of low fractures

Disadvantages

Heterotopic bone formation
Interference with subsequent hip replacement

Skill level

Equipment

Main indications

Transtectal or juxtatectal fracture with more anterior displacement

Advantages for approach

No compromise of any subsequent hip replacement
Easier to control the anterior element of the fracture than with Kocher-Langenbeck
Much better soft tissue healing than with the extended iliofemoral approach

Disadvantages

More demanding approach and fixation than with Kocher-Langenbeck
Difficulties to stabilize low fractures
Joint not directly visualized

Transtectal or juxtatectal fracture with more anterior displacement

Advantages for approach

No compromise of any subsequent hip replacement
Easier to control the anterior element of the fracture than with Kocher-Langenbeck
Much better soft tissue healing than with the extended iliofemoral approach

Disadvantages