Acetabular Fractures

Excerpt

Acetabular fractures primarily occur in young people who are involved in high-velocity trauma. Since the advent of mandatory seatbelt use, there has been a significant reduction of acetabular fractures to an approximate incidence of 3 per 100000. There has been an increase in the number of acetabulum fractures resulting from a fall of fewer than 10 feet, likely due to the rise in osteopenia/osteoporosis. Little has changed since Letournel and Judet’s landmark paper in 1993, and many of their findings remain the “gold standard” for treatment today. Among the most significant advancements has been the advent of percutaneous fixation of certain fracture types.

Anatomy

The innominate bone forms from the pubis, ischium, and ilium at the triradiate cartilage. The superior portion of the acetabulum articular surface has the name of the weight-bearing dome. Blood supply to the external surface is via the superior gluteal artery, inferior gluteal artery, obturator artery, and medial femoral circumflex. Blood supply to the internal surface comes from the fourth lumbar, iliolumbar, and obturator arteries. One can visualize the articular surface as an inverted Y with a thick strut of bone connecting it to the sacroiliac (SI) joint, known as the sciatic buttress. The acetabulum divides into an anterior and posterior column. The anterior column contains the anterior half of the iliac wing that is contiguous with a pelvic brim to superior pubic ramus and anterior half of the acetabular articular surface. The posterior column begins at the superior aspect of the greater sciatic notch, contiguous with greater and lesser sciatic notches, and includes the ischial tuberosity.