Acetabular fractures, anatomy and implications for treatment

Acetabular fractures are relatively uncommon and their definitive treatment tends to be focused on specialist major trauma centres. This can make both accurate diagnosis and management challenging, particularly in hospitals where they are rarely seen. Contemporary management of these injuries owes a lot to the work of Judet and Letournel undertaken in the 1970s. The key to understanding these injuries is to know the embryology and development of the pelvis and then be able to appreciate its three-dimensional structure from two-dimensional X-rays. This can then be overlaid with the Judet classification and the action of force vectors encountered in various mechanisms of injury. It is also important to realise the ageing demographics of this group of patients and the complexities this adds to classification and ultimately treatment. Finally, the presence of an acetabular fracture is often seen in association with a number of other injuries. It is imperative that these are appropriately and contemporaneously diagnosed so that a comprehensive management plan may be instituted to give the best outcomes. However, even with optimal management the prognosis is guarded with a majority of patients suffering some degree of functional loss and this must be made clear to the patient from the outset.