The pelvic acetabulum injuries are rare injuries. Most displaced acetabular and pelvic fractures are appropriate for open reduction and internal fixation to restore anatomical reduction of the hip joint
A 33-year-old male patient came to the hospital ER with history of runover by a lorry. He complained of pain, swelling, deformity at pelvic area, and not able to stand. After resuscitating and stabilizing the patient, x-rays and CT scan of the pelvis was done. He was found to have fracture of the pelvis and acetabulum. The observed findings in CT and X-ray were involvement of the roof of the acetabulum, the anterior column of the acetabulum and subluxation of the right hip and displaced fracture of the left superior and inferior pubic rami and Sacro-iliac joint injury left side and moralle devalle lesion of the back.
After stabilisation of the patient and secondary survey, the surgery was done after 1 week.
The pubic rami and the anterior column fracture of the acetabulum was approached through anterior ilioinguinal approach in supine position. The pubic rami fracture was stabilised using 8 holed plate and 7 screws. The anterior column of the acetabulum was stabilised with 10 holed plate and 7 screws.
The posterior wall fracture of the acetabulum was approached through the posterior kocher langenbach approach in prone position. The femoral head was found subluxed. The femoral head was reduced and posterior wall, and roof of the acetabulum was fixed with spring plate and buttress plate. Pelvic Acetabular fracture.showing x-ray of pelvis involving fracture of the right acetabulum with anterior column, posterior wall, roof of the acetabulum fracture with dislocation of the femoral head and superior and inferior pubic rami of the left pelvis
The pelvic acetabulum injuries are rare injuries and difficult to operate. Careful planning of the surgery and open reduction, and perfect internal fixation are essential for good outcome of the patient. Its multidisciplinary work and involves clinical acumen with team work among orthopedics, Anesthesiologists and critical physicians. At our center, all the above departments worked hard to get the best outcomes.
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