Acetabular fractures: when is surgery needed?

Fractures of the acetabulum represent a significant challenging fracture for the orthopedic surgeon. The average orthopedic surgeon never gains wide experience with this relatively uncommon fracture. Acetabular fractures are, in fact, difficult to understand and treat successfully. Incongruity and instability of this major weight bearing joint should be ideally treated with anatomic reduction and early motion of the joint to prevent secondary osteoarthritis and to restore function of the joint in spite of general acceptance of the principles in the management of articular fractures like anatomic reduction, stable fixation, and early motion, factors such as comminution and complications continue to result in 20% of patients having less than perfect results. Joint congruity may be achieved and maintained by closed means, In which case the results usually are satisfactory. However, if incongruity between the femoral head and acetabulum remains after closed reduction, surgical intervention is the only alternative. But, technically, it is not possible in all cases. In fact, many factors can prevent the surgeon from achieving the desired goals, as for instance age of the patient, osteopenia, extreme comminution and the complications associated with these difficult surgical procedure. Primary total hip arthroplasty is a good alternative to open reduction and internal fixation in older patients with extreme comminution and incongruous or unstable hip.