[Complex injuries of the pelvis and acetabulum]

Abstract

Injuries of the joints of the pelvis and of the acetabulum are still a problem even today. When the joints of the pelvis are damaged the risk of complicated pelvic injuries, that is to say pelvic injuries with damage to the soft tissues in and around the pelvis, is increased threefold. The lethality, the overall gravity of the injuries, the probability of haemorrhagic complications and the proportion of associated pelvic injuries are also increased. Even when anatomical reconstruction of the lower limb girdle is achieved, long-term secondary conditions such as pain and genitourinary and neurological sequelae frequently persist. Complicated pelvic injuries, i.e. pelvic injury with concomitant damage to organs and soft tissues in the pelvis and pelvic injuries with ipsilateral femoral fracture (floating hip) are special cases. Haemodynamic stabilization of the patient and the treatment of organic lesions must be the first priorities in the interdisciplinary therapy. Even when these priorities are correctly observed, the lethality is almost three times as high as in the case of pelvic injuries not involving soft-tissue damage. Acetabular fractures are a particular challenge even compared with other joint fractures. Operative treatment with anatomical joint reconstruction and stable internal fixation has been shown to have the best results. In addition to the type of fracture and the personal experience of the surgeon concerned, such fracture-specific factors as the presence of further fractures of the posterior wall, comminuted fractures, joint depression fractures and intra-articular fragments increasingly play a part. The long-term result worsens with increasing number of these additional pathologies. The primary cartilaginous damage caused by the accident seems to have a considerable influence on the long-term result following acetabular fractures.