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Acetabular fracture, hip dislocation, hip reduction, fracture management, preoperative management
Preoperative management of acetabular fracture is a major problem and no consensus has been reached in literature on the optimal treatment of this problem. We present the results of the First Italian Consensus Conference on Acetabular fracture. An extensive review of the literature has been undertaken by the organizing committee and forwarded to the panel. Members were appointed by surgical experience with acetabular fractures. From November 2017 to January 2018, the organizing committee undertook the critical revision and prepared the presentation to the Panel on the day of the Conference. Then 11 recommendations were presented according to the 11 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on, a second debate took place in September 2018 to reach a unanimous consent. We present results of the following questions: does hip dislocation require reduction? Should hip reduction be performed as soon as possible? In case of unsuccessful reduction of the dislocation after attempts in the emergency department, how should it be treated? If there is any tendency toward renewed dislocation, how should it be treated? Should Computed Tomography (CT) scan be performed before reduction? Should traction be used? How can we treat the pain? Is preoperative ultrasound exam to rule out vein thrombosis always necessary? Is tranexamic acid intravenous (IV) preoperatively recommended? Which antibiotic prophylactic protocols should be used? Is any preoperative heterotopic ossification prophylaxis suggested?
In this article we present the indications of the First Italian Consensus Conference: a hip dislocation should be reduced as soon as possible. If unsuccessful, surgeon may repeat the attempts optimizing the technique. Preoperative CT scan is not mandatory before reduction. Skeletal traction is not indicated in most of the acetabular fracture. Standard pain and antibiotic prophylactic protocols for trauma patient should be used. Preoperative ultrasound exam is not recommended in all acetabular fracture. Tranexamic acid should be preoperatively used. There is no indication for preoperative heterotopic ossification.
 Oxford Centre for Evidence-based Medicine. Levels of Evidence. 2009. Accessed at http://www.cebm.net/ocebm-levels-of-evidence/
 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009;3:e123–30
 Holt GE, McCarty EC. Anterior hip dislocation with an associated vascular injury requiring amputation. J Trauma 2003;55(1):135-8.
 Kregor PJ, Templeman D. Associated injuries complicating the management of acetabular fractures. Orthopedic clinics of north America. 2002; 33:1.
 Epstein HC. Posterior fracture-dislocation of the hip: Long term follow-up. J Bone Joint Surg Am 1974; 56 (6):1103-27.
 Letournel E, Judet R. Fractures of the Acetabulum.New York, Springer, 1993.
 Matta JM. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996: 78:1632–45.
 Cash DJW, Nolan JF. Avascular necrosis of the femoral head 8 years after posterior hip dislocation. Injury 2007;38:865–7.
 Jaskolka DN, Di Primio GA, Sheikh AM, Schweitzer ME. CT of preoperative and postoperative acetabular fractures revisited. J Comput Assist Tomogr. 2014; 38(3):344-7.
 Halvorson JJ, Lamothe J, Martin CR, Grose A, Asprinio DE, Wellman D, Helfet DL. Combined Acetabulum and Pelvic Ring Injuries. J Am Acad Orthop Surg 2014;22:304-14.
 Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck: A metaanalysis of one hundred and six published reports. J Bone Joint Surg Am. 1994; 76:15–25.
 Frank M, Dzupa V, Smejkal K, Baca V, Dedek T. Crossover external fixator for acetabular fractures: a cadaver study. J Trauma Emerg Surg. 2014; 40:601–606.
 Pagenkopf E, Grose A, Partal G, Helfet DL. Acetabular Fractures in the Elderly: Treatment Recommendations. HSSJ. 2006; 2: 161–71.
 Sanders S, Tejwani N, Egol KA. Traumatic Hip Dislocation. A Review. Bulletin of the NYU Hospital for Joint Diseases. 2010;68(2):91-6.
 Clegg TE, Roberts CS, Greene JW, Prather BA. Hip dislocations--epidemiology, treatment, and outcomes. Injury. 2010;41(4):329-34.
 Mitsionis GI, Lykissas MG, Motsis E, Mitsiou D, Gkiatas I, Xenakis TA, Beris AE. Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: a study with a minimum follow-up of 15 years. J Orthop Trauma. 2012 Aug;26(8):460-5.
 Handoll HH, Queally JM, Parker MJ. Pre-operative traction for hip fractures in adults. Cochrane Database Syst Rev. 2011;(12):CD000168.
 Dijkstra BM, Berben SA, van Dongen RT, Schoonhoven L. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands. Eur J Pain. 2014 ;18(1):3-19.
 White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003;90:446–455.
 Montgomery KD, Potter HG, Helfet DL. The detection and management of proximal deep venous thrombosis in patients with acute acetabular fractures: a follow-up report. J Orthop Trauma. 1997;11:330-336.
 Slobogean GP, Lefaivre KA, Nicolaou S, O'Brien PJ. A systematic review of thromboprophylaxis for pelvic and acetabular fractures. J Orthop Trauma. 2009; 23 (5):379-84.
 Morgan SJ, Jeray KJ, Phieffer LS, Grigsby JH, Bosse MJ, Kellam JF. Attitudes of Orthopaedic Trauma Surgeons Regarding Current Controversies in the Management of Pelvic and Acetabular Fractures. Journal of Orthopaedic Trauma. 2001; 15 (7): 526–32.
 Böhme J1, Müller J, Fröhlich S, Tiemann AH, Josten C. Fatal risk thrombosis? A prospective study for the incidence of deep vein thrombosis in pelvic fractures. Z Orthop Unfall. 2009 ;147(3):293-7.
 Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012; 147(2):113–19.
 R. P. Piggott, M. Leonard. Is there a role for antifibrinolytics in pelvic and acetabular fracture surgery? Ir J Med Sci. 2016; 185:29–34.
 Roberts I, Shakur H, Ker K, Coats T. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev. 2012; (12):CD004896.
 Suzuki T, Morgan SJ, Smith WR, Stahel PF, Gillani SA, Hak DJ. Postoperative surgical site infection following acetabular fracture fixation. Injury. 2010 ;41(4):396-9.
 Iqbal F, Younus S, Asmatullah, Zia OB, Khan N. Surgical Site Infection Following Fixation of Acetabular Fractures. Hip Pelvis. 2017; 29(3): 176-81.
 Oliver D, Griffiths R, Roche J, Sahota O. Hip fracture. BMJ Clin Evid. 2007; 10: 1110 .
 Tornetta P. Displaced Acetabular Fractures: Indications for Operative and Nonoperative Management. J of the American Academy of Orthopaedic Surgeons. 2001; 9 (1): 18-28.
 Hanschen M, Pesch S, Huber-Wagner S, Biberthaler P. Management of acetabular fractures in the geriatric patient. SICOT J. 2017; 3: 37.
 Archdeacon MT, D’Heurle M, Nemeth N, Budde B. Is Preoperative Radiation Therapy as Effective as Postoperative Radiation Therapy for Heterotopic Ossification Prevention in Acetabular Fractures? Clin Orthop Relat Res. 2014; 472:3389–94.