Executive Editor: Richard Buckley

Authors: Tania Ferguson, Daren Forward

Acetabulum

back to skeleton

Glossary

Basic treatment techniques

Basic technique: spring hook plates

Posterior wall

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Stable hip with a concentric reduction, no intraarticular fragments confirmed on CT with a small posterior wall fragment in elderly patients Highly experienced and skilled surgeon Basic equipment only
ORIF through Kocher-Langenbeck Approach of choice, most suited to smaller, more inferior fragment of the posterior wall Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through trochanter osteotomy extension Larger, more superiorly extending posterior wall fragment Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Posterior column

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Undisplaced fractures (occur rarely) Highly experienced and skilled surgeon Basic equipment only
ORIF through Kocher-Langenbeck All displaced posterior column fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Anterior wall

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Most fractures with no intraarticular fragments identified on CT Highly experienced and skilled surgeon Basic equipment only
ORIF through ilioinguinal approach Large, isolated anterior wall fragment Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Anterior column

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment 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
ORIF through modified Stoppa approach Approach of choice when surgery is required Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through ilioinguinal approach Surgeon’s preference, associated anterior wall fragments Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Transverse

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Undisplaced fractures with a congruent hip joint, low infratectal fractures Highly experienced and skilled surgeon Basic equipment only
ORIF through Kocher-Langenbeck Displacement of mainly the posterior portion Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through modified Stoppa approach Transtectal or juxtatectal fracture with more anterior displacement Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through extended iliofemoral approach Comminuted, transtectal or juxtatectal fracture, displaced fracture with delayed presentation Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Posterior column and wall

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Stable hip with a concentric reduction, no intraarticular fragments identified on CT with a small posterior wall fragment in an elderly patient Highly experienced and skilled surgeon Basic equipment only
ORIF through Kocher-Langenbeck Approach of choice, most suited to smaller, more inferior fragment of the posterior wall Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Transverse and posterior wall

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Stable hip with a concentric reduction, no intraarticular fragments identified on CT with a small posterior wall fragment or low infratectal fractures in an elderly patient Highly experienced and skilled surgeon Basic equipment only
ORIF through Kocher-Langenbeck Approach of choice, most suited to smaller, more inferior fragment of the posterior wall Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through extended iliofemoral approach Significant anterior displacement of the transverse element of the fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

T-type

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Undisplaced fractures, elderly or unfit patients Highly experienced and skilled surgeon Basic equipment only
ORIF through modified Stoppa approach Approach of choice when surgery is required Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through ilioinguinal approach Surgeon’s preference, anterior wall fragments associated with anterior column fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through sequential approaches Displaced posterior-inferior quadrant of T-type fracture following anterior approach and fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through extended iliofemoral approach Displaced anterior and posterior-inferior elements Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Anterior column and posterior hemitransverse

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Minimally displaced fractures, poor quality bone, elderly less fit patients, comminuted joint fragments, early hip replacement Highly experienced and skilled surgeon Basic equipment only
ORIF through modified Stoppa approach Approach of choice when surgery is required Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through ilioinguinal approach Surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through sequential approaches Displaced anterior element of the anterior column and posterior hemitransverse fracture following anterior approach and fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Both columns

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Undisplaced fractures, highly comminuted fractures planned for a delayed total hip replacement which may include fractures with secondary congruence Highly experienced and skilled surgeon Basic equipment only
ORIF through modified Stoppa approach Approach of choice when surgery is required Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through ilioinguinal approach Surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through sequential approaches Displaced posterior elements following anterior approach and fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF through extended iliofemoral approach Displaced anterior and posterior elements Highly experienced and skilled surgeon Full specialized surgical and imaging resources
*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