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J Am Acad Orthop Surg, Vol 9, No 1, January/February 2001, 18-28.
© 2001 the American Academy of Orthopaedic Surgeons
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Displaced Acetabular Fractures: Indications for Operative and Nonoperative Management

Paul Tornetta, III, MD

Dr. Tornetta is Associate Professor and Vice Chairman, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Mass; and Director of Orthopaedic Trauma, Department of Orthopaedics, Boston Medical Center.

Reprint requests: Dr. Tornetta, Department of Orthopaedics, Boston Medical Center, Dowling 2 North, 818 Harrison Avenue, Boston, MA 02118.

Displaced acetabular fractures are a challenging problem. In contradistinction to most conditions in which surgery is based on specific operative indications, displaced acetabular fractures should be considered an operative problem unless specific criteria for nonoperative management are met. These include a congruent hip joint on the anteroposterior and oblique (Judet) radiographs, an intact weight-bearing surface (as defined by roof arc and subchondral arc measurements on computed tomographic scans), and a stable joint. The final decision about the treatment method must also consider the patient’s functional demands, expectations, and physical condition and the physician’s experience and institutional support for dealing with this type of injury. Displaced both-column fractures with secondary congruence may have better results than other displaced fractures. In older patients, nonoperative management may be effectively utilized. Understanding the current criteria for effective use of nonoperative treatment will help the surgeon make these difficult decisions.




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Copyright © 2001 by the American Academy of Orthopaedic Surgeons.