Authors of section

Authors

Derek Donegan, Michael Huo, Michael Leslie

Executive editor

Michael Baumgaertner

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Intraoperative acetabular fracture during insertion, not recognized intraoperatively

General considerations

Acetabular fracture occurring intraoperatively during hip arthroplasty but recognized only after surgery are classified as type IC by Della Valle.

They can be simple or complex. Cup may be stable or unstable.

  • Fracture pattern can be stable or unstable
  • High risk of loss of cup stability
  • Patient can be clinical symptomatic or asymptomatic.
  • This diagnosis is often made on routine post-surgery follow-up imaging
  • On occasion, CT and Judet views are helpful to fully define the fracture pattern.

Further information about Della Valle classification can be found in the publication: Della Valle CJ, Momberger NG, Paprosky WG. Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect. 2003;52:281–290.

Della Valle IC acetabular fracture

Etiology

  • Excessive or eccentric reaming leading to reduction of bone strength
  • Mismatch of cup size to the reaming preparation
  • Eccentric cup insertion leading to stress of the walls/columns

Clinical signs

  • Pain
  • Joint dysfunction

Imaging

  • Regular radiographs including Judet views
  • CT scan