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Acetabular Fracture Patterns and Their Associated Injuries

Objectives: Characterize relationships between acetabular fractures patterns and visceral organ injuries. Design: Retrospective review. Setting: University medical center. Patients/Participants: Three hundred twenty-three patients with displaced acetabular fractures identified in a prospectively maintained database. Intervention: Acetabular fractures were classified according to force vector at the time of injury. Posterior wall, posterior column, and posterior column/posterior wall injuries were assumed to have been caused by an axial load. The remaining seven acetabular fracture types were assumed to have resulted from a lateral or trochanteric load. Records were reviewed to establish any relationship between acetabular fracture patterns defined by their force vector and injuries to other skeletal and nonskeletal organ systems. Main Outcome Measurements: Comparison of organ injury end points of additional skeletal injury; bowel, bladder, brain, kidney, liver, spleen, and lung injury; retroperitoneal hematoma; and vascular injury of the pelvis. Data were analyzed using chi-square, with statistical significance defined as P < 0.05. Results: Acetabular fractures resulting from lateral loads had a statistically higher association with retroperitoneal hematomas (P < 0.001), spleen (P < 0.008), liver (P < 0.002), vascular (P < 0.001), kidney (P < 0.001), and bladder (P < 0.001) injuries than did posteriorly directed acetabular fractures. Transverse posterior wall fractures exhibited intermediate characteristics between axial load and the remaining lateral load patterns. Conclusions: Direction of force is important in the etiology of nonskeletal injury patterns. The possibility of additional nonskeletal injury increases from the rates seen in axial load patterns to those in lateral load patterns involving the anterior column.