Executive Editor: Richard Buckley

Authors: Tania Ferguson, Daren Forward

Acetabulum - Anterior column

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Glossary

General considerations

This category represents a large range in anatomical location, fracture comminution and complexity.

Many fractures are not greatly displaced and can be treated nonoperatively.

More severe fractures can be extremely challenging even for experienced surgeons.

Surgery is urgent for:

  • Irreducible dislocation
  • Hip joint incongruity with risk of femoral head damage

ORIF is the optimal operative treatment for most fractures. For severe arthrosis or osteoporosis, total joint replacement should be considered.

Nonoperative treatment
Main indication Skill Equipment
Minimally displaced fractures, poor quality bone, elderly less fit patients, comminuted joint fragments, patients suitable for planned hip replacement Highly experienced and skilled surgeon Basic equipment only

Indications

  • Congruently reduced hip joint
  • Stable hip joint through range of motion
  • No evidence of progressive displacement

Advantages

  • Avoidance of risk of surgery

Disadvantages

  • Residual displacement may compromise hip replacement
ORIF through modified Stoppa approach
Main indication Skill Equipment
Approach of choice when surgery is required Highly experienced and skilled surgeon Full specialized surgical and imaging resources

This approach may be also combined with a lateral window.

Indications

  • Displaced anterior column fracture
  • Incongruent hip joint

Advantages for approach

  • Much improved visualization of the column
  • Direct instrumentation of the quadrilateral surface
  • Easy control of the corona mortis
  • Easy access to the pubic symphysis
  • Reduced dissection of the inguinal canal

Disadvantages

  • Difficulty to fix small peripheral anterior wall fragment associated with the anterior column fracture
ORIF through ilioinguinal approach
Main indication Skill Equipment
Surgeon’s preference, associated anterior wall fragments Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Displaced high anterior column fracture
  • Incongruent hip joint

Disadvantages

  • Difficulty with visualization and control of hemorrhage from the corona mortis
  • Difficulty with instrumentation of the quadrilateral surface
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2017-11-27