Acetabular fracture

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Classification according to ICD-10
S32.- Fracture of the lumbar spine and pelvis
S32.4 Fracture of the acetabulum
ICD-10 online (WHO version 2019)

An acetabular fracture is a fracture of the acetabulum . It is caused by direct force (usually on the greater trochanter ) or indirect force (usually impact of the knee on the dashboard) and is usually associated with a hip dislocation in the direction of the fracture. The sciatic nerve is at risk at the rear and the femoral nerve at the front .

Symptoms

In addition to local signs of injury and impaired function, a malposition or shortening of the leg is noticeable. Excluded are pure dislocations and an accompanying femoral head , femoral neck fracture , pelvic fracture or vascular and nerve damage. An X-ray overview of the pelvis is carried out, often supplemented by an Ala image and an obturator image (45 ° beam path with raised healthy or sick hips) or CT .

AO classification

The AO classification differentiates between the following fracture types:

Type A vertical fracture line leaves an anterior or posterior static pillar intact:

  • Type A 1: fracture of the posterior rim of the acetabulum
  • Type A 2: fracture of the posterior pillar
  • Type A3: fracture of the anterior acetabular rim and abutment

Type B Horizontal fracture line destroys the statics, but at least part of the upper edge of the socket (on the iliac bone ) is intact:

  • Type B 1: Horizontal break line
  • Type B 2: T-shaped break line
  • Type B 3: horizontal fracture line at the front, vertical at the rear

Type C Horizontal fracture line with a long course completely separates acetabular fragments from the iliac bone :

therapy

Non-displaced acetabular fractures (<2 mm) can be treated conservatively; all others must be precisely repositioned and flattened .

Healing prospects

Damage to articular cartilage or the femoral head can lead to hip arthrosis or femoral head necrosis in the long term .

literature

  • Andreas Hirner, Kuno Weise: Surgery cut by cut. Thieme, Stuttgart 2004, ISBN 3-13-130841-9 , pp. 306-307.