Fractures of the acetabulum. A retrospective analysis.

A roentgenographic analysis of 204 acetabular fractures is presented. In addition, 64 displaced fractures (43 treated surgically) are evaluated clinically and roentgenographically (average follow-up period, 3.7 years). Most fractures can be adequately evaluated from anteroposterior and oblique roentgenograms of the pelvis. The roentgenographic and clinical results correlate closely. Fractures must be reduced to a displacement of 3 mm or less, in addition to congruent reduction of the femoral head with the weight-bearing dome of the acetabulum, to achieve a satisfactory clinical result. Most displaced fractures involve the weight-bearing dome and require surgery. With an intact weight-bearing dome, nonoperative treatment is considered. Quantification of this dome with three measurements termed the medial, anterior, and posterior roof arc obtained from the standard roentgenograms is valuable in determination of appropriate treatment for displaced acetabular fractures.

Posterior fracture dislocation of the hip with fractures of the femoral head.

In general, all traumatic dislocations of the hip must be treated as surgical emergencies. Multiple attempts at closed reduction are contraindicated, particularly in Type V dislocations. Every effort must be made to recognize the dislocation, particularly in patients with other severe lower extremity trauma. Reduction within 24 hours gives better results than late reductions. Roentgenograms of the pelvis must include both hips after closed or open procedures as a check for a concentric reduction of the hip. Any abnormality, or failure to reduce the avulsed head fragment, demands an immediate hip arthrotomy. The good results, after primary open reduction, although under 50%, were better than closed or closed followed by open reduction. Our approach is to discard the avulsed head fragment. No conclusions can be made regarding screw fixation of the avulsed fragment because there was an insufficient follow-up period in this procedure. Long-term follow-up examination is necessary in Type V fracture dislocations because one can anticipate that arthritic changes will develop in more than 50% of patients. Anterior approaches to excise head fragments in Type V dislocations are contraindicated. Early intervention is indicated in all dislocations with sciatic or peroneal nerve paralysis. Because most dislocations in this series were due to automobile accidents, the routine use of seat belts could have prevented many of these injuries.

Treatment of unreduced traumatic posterior dislocations of the hip.

A study was made of thirty-nine traumatic posterior dislocations of the hip that had remained unreduced for from three days to nine years. The purpose of the review was to compare the results of closed and open reduction with those of primary reconstructive surgery. Three of the twenty hips that had closed or open reduction had good results as compared with ten of the thirteen hips that had primary reconstructive surgery. Six hips that were left dislocated had uniformly poor results.

Posterior fracture-dislocations of the hip; long-term follow-up.

Of 242 posterior fracture-dislocations of the hip, of which 150 had been followed for from four to twenty-seven years (over-all average, seven years and three months), 112 were treated by closed reduction; and fifty-six, by primary open reduction. Satisfactory results were obtained in 12 per cent of the hips treated by closed reduction, in 42 per cent of those treated by closed reduction followed by open reduction, and in 63 per cent of those treated by primary open reduction with removal of all loose fragments of bone and cartilage and restoration of stability by internal fixation of the fracture of the acetabular rim offers the best prognosis.