Post-traumatic arthritis is the primary clinical problem following displaced acetabulum fractures. Disruption of the acetabulum leads to alteration of the normal cartilage pressure distribution and subsequent destruction of articular cartilage. Initial AP and 45° oblique views of the pelvis as well as CT scanning lead to the proper fracture classification and nonoperative versus operative decision making. A trial of closed reduction is not usually an integral part of the evaluation. Fractures chosen for nonoperative treatment are expected to have a satisfactory clinical result despite articular displacement. Included in this category are fractures involving only inferior areas of the acetabulum and both column fractures with secondary congruence. The majority of displaced fractures do not meet the criteria for closed treatment and should be treated by open reduction and internal fixation. No one surgical approach is appropriate for all fractures, so an accurate preoperative radiographic interpretation is essential. The most effective surgical approaches are the Kocher-Langenbeck, extended iliofemoral, and ilioinguinal approaches.
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