Fractures of the acetabulum: from yesterday to tomorrow
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REVIEW ARTICLE
Fractures of the acetabulum: from yesterday to tomorrow Matej Cimerman 1
&
Anže Kristan 1 & Marko Jug 1 & Matevž Tomaževič 1
Received: 29 July 2020 / Accepted: 8 September 2020 # The Author(s) 2020
Abstract Purpose The aim of this article is to present history, state of the art, and future trends in the treatment of acetabular fractures. Methods Review of recent and historical literature. Results Acetabular fractures are difficult to treat. The first descriptions of this injury already appeared in ancient Greek history, but intensive development started in the second half of the twentieth century after Judet and Letournel’s seminal work. Their classification is still the gold standard today. It is actually a pre-operative planning system and is used to determine the most appropriate surgical approach. The therapy of choice for dislocated fractures is open reduction and internal fixation. Recent modern techniques based on high-tech computerized planning systems and 3D printing have been successfully integrated into orthopaedic trauma practice. Conclusion There is no ideal surgical approach for acetabulum fracture treatment, so new approaches have been developed in recent decades. The best outcome series have shown good or excellent results, between 70 and 80%. Keywords Acetabulum . Fracture . Planning . Approaches . History
Introduction Acetabular fractures are among the most demanding injuries treated by orthopaedic trauma surgeons. The incidence is three patients/100,000/year [1], so even in a busy European trauma centre, the case load is relatively small and it is difficult to gain enough experience. There are a lot of challenges in acetabular fracture surgery. The 3D morphology of the fracture is complex, and the choice of surgical approach is not always straightforward. Surgical approaches are demanding, and anatomical reduction, which is the most decisive factor for good long-term outcome [2], can pose difficulties, even for the most experienced surgeons. In this review article, we summarize the development and state of the art of the surgical treatment of acetabular fractures.
Historical overview The first and for a long time the only description of acetabular fracture came from Homer’s Iliad, written during the eighth * Matej Cimerman [email protected] 1
Traumatology Department, Division of Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
century BC. The poetic description of acetabular injury in Iliad is as beautiful as it is accurate and should be read by every acetabular surgeon: “Just as Diomedes hefted a boulder in his hands, a tremendous feat — no two men could hoist it, weak as men are now, but all on his own he raised it high with ease, flung it and struck Aeneas’s thigh where the hip bone turns inside the pelvis, the joint they call the cup — it smashed the socket, snapped both tendons too, and the jagged rock tore back the skin in shreds. The great fighter sank to his knees, bracing himself with one strong forearm planted against the earth, and the worl
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