Date: Fri, 4 Jul 2003 18:11:09 +1000

Subject: Acetabular (Ant column & wall) Fx

Could I have the groups' advice on this fracture and treatment?

63 year old male, simple fall 4 days ago with an undisplaced Right Surgical neck of humerus fracture and this acetabular fracture. My assessment is that it is an anterior wall & column fracture with a blow out of the quadrilateral plate. the posterior column is intact. I see the immediate options as an attempted closed reduction and traction or an open reduction. I am right in saying this would need to be openly reduced through an ilioinguinal approach (which I have never seen or done). Or do I wait and do his Total Hip Replacement when his fracture has healed?

Thanks

Dr. Warren Seager
Orthopaedic Surgeon
Wangaratta, Victoria, Australia.

Date: Sat, 5 Jul 2003 11:50:38 -0400

From: Peter Trafton

I agree with your diagnosis, and would suggest closed reduction under general anesthesia as soon as safe & convenient - distal traction, perhaps supplemented with lateral traction via a sheet looped around the proximal thigh. It would be nice to protect his articular surfaces with a reduction, even though it could prove unstable, even in skeletal traction, which I would use after the reduction attempt.

Next would be ORIF, via an ilioinguinal incision by an experienced surgical team. If you are unable, he should be referred appropriately, and could travel safely in traction via air or ground ambulance, depending upon distance.

Expected result of ORIF of this injury would be a durable, good hip joint, rarely requiring THA.

/p