The cranial unstable transverse acetabulum fracture: an important variant.

PURPOSE

Achieving anatomic reduction in combined injuries of the pelvic ring and acetabulum is critical to optimizing outcome. One of the most common combined patterns is a transverse-type acetabular fracture with associated ipsilateral sacroiliac joint instability. The optimal order of fixation (pelvis-first versus acetabulum-first) in these patients remains unclear. The present study aimed to analyze the impact of operative sequence on outcomes when treating transverse variant acetabulum fractures with concomitant posterior pelvic ring disruption.

METHODS

Across a 12-year period, 24 patients with transverse variant (e.g., transverse, transverse posterior wall, or T-type) acetabulum fractures with unstable cranial segments were identified. This cohort included 17 patients treated with a pelvis-first approach and 7 patients treated with an acetabulum-first approach. Data regarding demographics, mechanism, associated injuries, operative details, post-operative reduction quality, and clinical outcomes were collected.

RESULTS

The average age in this series was 37 years, and 63% of patients were male. All injuries involved a high-energy mechanism, most commonly motor vehicle collision (63%). There were no significant differences in demographic or injury characteristics between cohorts. A pelvis-first approach was associated with a significantly lower rate of poor reduction quality (12% vs. 57%, P = 0.038) and lower blood loss on average (500 mL vs. 1000 mL, P = 0.009) when compared to an acetabulum-first approach.

CONCLUSION

In this series, a pelvis-first approach was associated with improved reduction quality and decreased blood loss among patients with operatively managed transverse acetabulum fractures with a cranial unstable fracture fragment.

LEVEL OF EVIDENCE

IV.