- Discussion:
- central frx/dislocation is crippling injury with a poor prognosis;
- extensive degree of concomitant articular injury occurs;
- 22% incidence of sciatic nerve injury;
- distal and occassionally, lateral traction of proximal femur may be necessary to effect and maintain reduction of the femoral head;
- total hip arthroplasty may be the treatment of choice;
- Types of Fractures:
- undisplaced fractures (either single line or stellate types)
- inner wall frx:
- femoral head concentrically reduced beneath dome on initial films;
- head not reduced under acetabular dome but centrally dislocated;
- superior dome frx:
- gross outline of acetabular dome intact & congruous w/ fem head
- gross outline of acetabular dome not intact nor congruous w/ femoral head;
- bursting frx (all elements of the acetabulum involved)
- congruity remains between femoral head & acetabular dome
- there is incongruity between femoral head & acetabular dome
- Treatment:
- once the head/acetabular relationship is restored, pt is maintained in longitudinal traction for 10-12 weeks;
- lateral traction thru a trochanteric pin is used to reduce the joint and if necessary can be maintained for 8-10 weeks if necessary;
- Complications:
- infection in the retroperitoneal space:
- central frx dislocation of femur is frequently accompanied by retroperitoneal bleeding;
- if pin tract infection occurs around fixation device in greater trochanter, infection could spread to involve retroperitoneal space;
- residual joint incongruity
- References:
Internal fixation of osteopenic acetabular fractures involving the quadrilateral plate
The "Gull Sign": a harbinger of failure for internal fixation of geriatric acetabular fractures