بسم اللـه الرحمن الرحيم Incidence of the Acetabuar Fracture In AL-Thawra Modern general hospital During 2009 –Sana'a-Yemen
د.سعيد عبد الله بامشموس د. صالح مقبل الفيصلي
Ant. View of ACETABULAM
Post. View of ACETABULAM
. Callisen in 1788 start to said and to have reported the case of an acetabular fracture
During 2009 70 patients with acetabular fractures 6
Gender distribution of 70 patients with acetabular fractures 14(20%) 56 cases(80%)
The main cause of fracture is DISLUCATION OF THE HIP
● this injury is due to massive force transmitted along the femoral shaft, e.g. road traffic accidents or a back injury in someone kneeling.
distribution of 70 patients with acetabular fracture according to mechanism of injury GENDER FEMALE MECHANISM OF TRAUMA % T 57% 40 RTA 7% 5 GUN SHOT 30% 21 FALLING 6% 4 OTHER 100.00% 70 TOTAL
Type of Dislocation depends on position : 13
I. Anterior dislocation of hip 7-10% OF DIS NON FRACTURE OF ACETABULAM
II. Posterior dislocation Most common type of dislocation. Posterior rim is usually fractured Associated sciatic nerve injury in 10%
flexed, shortened, adducted and internally rotated 16
This is a fracture -dislocation. III. CENTRAL dislocation Direct impact to the aspect of the hip through the acetabulum. This is a fracture -dislocation.
Distribution of the acetabualr fracture by age group and gender TOTAL GENDER AGE GROUPS % N F M 7% 10 3 7 19-20 30.1% 43 36 21-30 8.4% 12 1 11 31-40 2.1% 4 41-50 6.3% 9 2 51-60 100.00% 70 14 56
I. AP View pelvis
ACETABLUM FEMORAL HEAD FEMORAL NECK GREATER TROCHANTER FOVEA CAPITIS Vastus lateralis attaches to greater trochanter; the obturator internus, superior and inferior gamelli attach to the medial surface of the greater trochanter, Guteus medius to the lateral surface of the greater trochanter, and gluteus minimus to anterior surface of greater trochanter. Iliopsoas attaches to lesser trochanter Pectineus attaches just distal to the lesser trochanter LESSER TROCHANTER CORTICAL BONE MEDULLARY BONE 21
II. JUDET view OBTURATOR (Internal oblique view)
III . JUDET view Iliac (exteternal oblique view)
WE CAN DIAGNOSED THE FRACTURE IN ONE OF 3 VIEW
CT is a very useful to assessment and planning of surgery.
27
70 patients with acetabular fracture accoding to associated injures TOTAL ASSOCIATED TRAUMA % N 38% 27 MULTIBLE TRAUMA 62% 43 ISOLATED ACETABULAR FRACTURE 100% 70
Distrubiton of acetabular fracture according to departement of intial admission DEPARTMENT TOTAL GENDER % T F M 10% 7 2 5 INTENSIVE CARE UNIT 12.8% 9 SURGICAL DEP. 61.4% 43 8 35 ORTHOPEDIC DEP. 7% 1 4 NEUROSURGICAL DEP. 8.5% 6 UROLOGY DEP. 100% 70 14 56
associated injury
distribution of complication releated to the associated injury in 27 patients: ASSOCIATED INJURIE % N 22.2 6 LIMBS 16.2 3 VASCULAR 11.6 2 NEUROLOGY 33.3 9 UROLOGY 4.6 ABOMINAL 2.3 4 THORACIC 38% 27 TOTAL
We used Letournel ANATOMICAL system classification
TYPE OF CLASSIFICATION % NO TYPE OF CLASSIFICATION SIMPLE FRACTURE TYPE 28% 20 posterior wall 4.2% 3 posterior column 1.4% 1 anterior wall 2.8% 2 anterior column 10% 7 transverse
ASSOCIATED FRACTURE TYPE 1.4% 1 posterior column +posterior wall 15.7% 11 transverse +posterior wall 7% 5 T- shape 11.4% 8 anterior column or wall + posteriorhemitransverase 17% 12 both column
Treatment I. Closed reduction ( to reduce pain ) II. SURGICAL
Closed reduction Four methods of closed reduction :
1.
2. Allis traction
3.
4 .Classical watson`s– jones method :
Skin Traction
Skeletal traction
II. SURGICAL treatment should be considered for: . all displaced fractures of the acetabulum. . that do not meet the criteria for nonoperative therapy.
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