1. بسم اللـه الرحمن الرحيم
Incidence of the Acetabuar Fracture
In AL-Thawra Modern general hospital
During 2009 –Sana'a-Yemen

2. د.سعيد عبد الله بامشموس د. صالح مقبل الفيصلي

3. Ant. View of
ACETABULAM

4. Post. View of
ACETABULAM

5. . Callisen in 1788 start to said and to have reported the case of an acetabular fracture

6. During 2009
70 patients
with
acetabular fractures 6

7. Gender distribution of 70 patients with acetabular fractures
14(20%)
56 cases(80%)

9. The main cause of fracture is
DISLUCATION OF THE HIP

10. ● this injury is due to massive force transmitted along the femoral shaft, e.g. road traffic accidents or a back injury in someone kneeling.

11. 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

13. Type of Dislocation depends on position :13

14. I. Anterior dislocation of hip
7-10% OF DIS
NON FRACTURE
OF ACETABULAM

15. II. Posterior dislocation
Most common type of dislocation.
Posterior rim is usually fractured
Associated sciatic nerve injury in 10%

16. flexed,
shortened,
adducted and
internally rotated 16

17. This is a fracture -dislocation.
III. CENTRAL dislocation
Direct impact to
the aspect
of the hip
through
the acetabulum.
This is a fracture -dislocation.

19. 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

20. I. AP View pelvis

21. 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

23. II. JUDET view
OBTURATOR
(Internal oblique view)

24. III . JUDET view
Iliac (exteternal oblique view)

25. WE CAN DIAGNOSED
THE FRACTURE
IN ONE OF 3 VIEW

26. CT is a very useful to assessment and planning of surgery.

27. 27

28. 70 patients with acetabular fracture accoding to associated injures
TOTAL
ASSOCIATED TRAUMA % N
38% 27
MULTIBLE TRAUMA
62% 43
ISOLATED ACETABULAR FRACTURE
100% 70

29. 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

30. associated injury

31. 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

32. We used Letournel ANATOMICAL system classification

33. 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

34. 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

36. Treatment
I. Closed reduction
( to reduce pain )
II. SURGICAL

37. Closed reduction
Four methods of closed reduction :

38. 1.

39. 2. Allis traction

40. 3.

41. 4 .Classical
watson`s– jones method :

42. Skin Traction

43. Skeletal traction

44. II. SURGICAL treatment should be considered for:
. all displaced fractures of the acetabulum.
. that do not meet the criteria for nonoperative therapy.

45. Orthopaedic Surgeon Can Get You Back Into The Game