Complex acetabular fractures.

Displaced acetabular fractures belonging to the associated fracture group described by Judet and Letournel present a formidable diagnostic and therapeutic challenge. Of 116 acetabular fractures, 31 had associated fracture types with follow-up evaluation of one year or longer. The patients' mean age was 30.7 years, their mean injury severity score was 15, and the average follow-up period was 21 months. Four patients had failed previous acetabular surgery. Operating time averaged 4.5 hours. Mean blood loss was 1150 cc. Clinical results were satisfactory in 77% of cases, with 11 excellent, 13 good, four fair, and three poor results. Complex acetabular fractures can be reduced by a combined anterior and posterior approach designed by the authors. This approach offers significant advantages for visualization and stabilization of these fractures. The combined approach is recommended for the surgeon who has mastered the single-approach techniques for standard, simple fracture patterns.