INDICATIONS, TECHNIQUES AND COMPLICATIONS IN SURGICAL-TREATMENT OF THE ACETABULUM

Almost 50% of acetabular fractures occur in polytraumatized patients; in over 80% additional injuries are found. The surgical goal is anatom ical restoration of the acetabulum and stable fixation, in order to av oid postoperative external fixation. Careful clinical and radiological evaluation is essential to successful surgery. Standard radiological investigations include an anteroposterior view of the pelvis, a ''spot '' radiograph of the affected hip as well as obturator and iliac obliq ue views. The latter are is especially helpful in assessing the centra l segment of the acetabulum (''dome fragment''). The documentation of any primarily traumatic sciatic nerve lesion is very important, and th e quality of reduction depends greatly on the timing of surgery. The o peration should be performed as early as possible after the surgical p rocedure has been carefully planned. A 3-D CT scan provides good infor mation in choosing the surgical approach for complex fractures. In mos t cases, adequate reduction cannot be accomplished without appropriate aids. For internal fixation both curved ASIF plates and straight plat es are used. The operation demands a high degree of experience.Postope rative complications include iatrogenic nerve palsy, insufficient redu ction, incorrectly placed implants, unstable fixation, redislocation, etc. With scrupulous aseptic conditions, the postoperative wound infec tion rate is low. Ectopic bone formation can occur after extensive sur gical approaches and may, depending on size (Brooker III and IV), impa ir the range of motion of the hip. Indometacin given perioperatively i s always indicated. Postoperative radiation treatment should as a rule be viewed critically.