Acetabular fractures: indication, technique and results of conservative treatment

Abstract

Despite the great number of publications during the last 10 years concerning the indication, technique and results of operative treatment of acetabular fractures, conservative treatment still has an important role when considering the therapeutic possibilities. Because of the modern techniques of radiological imaging and improvement of diagnostic facilities, a more defined indication for treatment becomes possible. Conventional X-rays, completed by special projections like the Ala and Obturator view, and a CT scan allow determination of the fracture type (the Letournel/Judet classification or the AO classification). The most suitable treatment can then be adapted to the individual circumstances of the patient, i. e., age, general condition and overall severity of traumatic impairment. Determination of the intact part of the weight-bearing dome is important in selecting the most adequate therapeutic procedure. The larger the intact roof arc, the better the prognosis. Together with the X-ray controls following axial and facultative lateral extentions, the indication for conservative treatment can be confirmed. Early active motion of the injured limb, followed by walking exercises with partial weight-bearing, are important aspects of nonoperative treatment. Conservative treatment is recommended in non-displaced fractures or in fractures with little displacement, transverse fractures of the lower region or severely comminuted acetabular fractures with no possibility of reconstruction. Our clinical and radiological follow-up of 97 patients with acetabular fractures from the years 1981-1990 showed that the majority were treated conservatively (approx. 70 %). The functional result after an average observation period of more than 70 months was good or excellent (based on the Merle d'Aubigné score). We feel it is important to look at operative and conservative treatment of acetabular fractures as two complementary non-competitive therapeutic methods. The choice of treatment should be based on an exact diagnosis considering fracture type, the individual circumstances of the patient, and application of the necessary diagnostic facilities. Conservative treatment can lead to excellent long-term results.

Fractures of the Accetabulum - Treatment Strategies and Actual Diagnostics

“…Frakturen des Azetabulums galten lange Zeit nur als konservativ erfolgreich therapierbar. Durch grundlegende Arbeiten von Judet und Letournel [13], der stetigen Verbesserung der systematisierten Röntgenanalyse und der daraus abgeleiteten Klassifikationen und Therapiemöglichkeiten konnte sich auch die operative Behandlung der Azetabulumfraktur etablieren [2,6,8,10,15,16,18,33]. Dabei wurden auch heute noch verwendete vordere und hintere Standardzugänge zum Azetabulum (Kocher-Langenbeck, Ilioinguinaler Zugang) [4,12,17,18] entwickelt, die als echte "Arbeitspferde" in über 90% der Frakturtypen zu einer vollständig anatomischen Rekonstruktion der Fraktur genutzt werden können.…”

“…Eine primäre oder sekundäre Gelenkkongruenz oder minimale Dislokation bei radiologisch sichtbarer Fraktur stellt auch heute noch in über 50 % der Fälle eine Indikation zum konservativen Vorgehen dar [6,10,21,33]. Ebenso können Komorbidität oder anderweitige Kontraindikationen zu einer konservativen Behandlungsstrategie zwingen.…”