![]() Fig. 1B: Marking of the osteochondral fragment in dome impaction in 3D CT and correspondingly on X ray. 7Ī: 3D CT scan showing dome impaction fracture of acetabulum which resembles a Sea Gull wings in flight on a X ray AP view – ‘See Gull Sign’. 5, 6 The incidence of marginal impaction in acetabular fractures involving the posterior wall is about 30%. 3, 4 Letournel and Judet described the term ‘Marginal impaction’ fracture, which is defined as a rotated and impacted, with depression of osteo-cartilaginous fragment of the posterior part of acetabulum that occurs in conjunction with a posterior fracture dislocation of the hip. 2 These articular dome impaction fractures are commonly observed in elderly patients particularly with osteoporosis as a result of low velocity injury. ‘Sea gull’ sign is pathognomonic sign seen in acetabular roof compression fractures, where a typical double arc shadow resembling sea gull wings in flight is observed. 1 Fracture forces in such injuries leads to compaction of underlying cancellous bone, when disimpacted they often require grafting or bone substitutes to fill the void. These incarcerated fracture fragments are often termed as harbinger for failure following internal fixation. ![]() Both the patterns, when unreduced properly lead to early arthritis and hip joint instability particularly with unreduced posterior wall impaction injuries. In this article we reviewed the characteristics of impaction injuries of acetabulum exploring surgical procedures, approaches and techniques for achieving open reduction and internal fixation.Īcetabular impaction fractures could be either ‘dome impaction’ fractures or ‘Posterior wall marginal impaction’ fractures of acetabulum. In cases of severe comminution, reconstruction of the wall defect with autologous graft is a better treatment option. Bone grafting either by auto or allograft or graft substitutes in the void after disimpaction helps in reducing anatomically and provide mechanical support adequately. Emphasis of early mobilisation should not drive the surgeon towards the motive of rigid fixation of columns alone, as the inadequate reduction of acetabular impaction leads to loss of mechanical support on weight bearing and thereby cause loss of reduction. CT scan is the best modality to analyse the site, extent of impaction and plan strategies to reduce. Dome impaction injuries and marginal impaction injuries have to be properly planned pre-operatively with respect to surgical approach, disimpaction techniques and fixation strategies. Acetabular impaction fractures when not adequately addressed leads to early arthritis.
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