Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Fractures of the Pelvis and Hip
 


> PELVIC RING FRACTURES
> ACETABULAR FRACTURES
> FRACTURES OF THE PROXIMAL FEMUR (HIP FRACTURES)
> HIP DISLOCATIONS




ACETABULAR FRACTURES

The fracture disrupts the congruence of the femoral head with the acetabulum and causes damage to the articular surface. A small number of fractures will be combined acetabular and pelvic ring injuries.

Evaluation

History and physical findings are similar to those in pelvic ring fractures.

:: Evaluate and treat hypovolaemic shock and visceral organ damage as an emergency (see page 13–8).
:: Evaluate sciatic nerve function and look for an associated femoral shaft fracture.
:: Obtain an initial anterior-posterior pelvic X-ray. If a fracture is evident, oblique views show the articular surfaces more clearly. X-ray the femoral shaft.

Treatment

Minimally displaced fractures

Treat minimally displaced fractures with bed rest and gradual mobilization. When comfortable, begin partial weight bearing until fracture healing has occurred. This usually takes about 12 weeks.

Displaced and unstable fractures
Treat displaced and unstable fractures with traction to maintain the congruence of the femoral head with the weight-bearing portion of the acetabulum. If a satisfactory position cannot be maintained, or if there are bone chips within the hip joint, surgical stabilization is indicated.

Do not send the patient to another hospital unless you are certain that this complicated surgery is available there.

> PELVIC RING FRACTURES
> ACETABULAR FRACTURES
> FRACTURES OF THE PROXIMAL FEMUR (HIP FRACTURES)
> HIP DISLOCATIONS



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  Kep Points  
Acetabular fractures result from high-energy pelvic injuries


Treatment aims to restore the congruence of the femoral head with the acetabulum by traction or by surgery if available



 
Complications include deep venous thrombosis, sciatic nerve injury and late degenerative arthritis of the hip.