Second, they demonstrated that the clinical and radiographic findings of the hip at one year were frequently representative of the long-term prognosis. The “burst” fracture, which was due to “upward and medial thrust” of the femoral head, demonstrated the worst outcomes. First, they clearly demonstrated that fractures that involve superior areas of the acetabulum have a worse prognosis than involvement of the inferior acetabular area. The Rowe and Lowell, article, however, while not discerning the specific fracture patterns, did demonstrate several important points that are still true today. Although these terms were informative and provided a starting point for understanding acetabular fractures, they lacked the detail necessary to guide the surgeon’s treatment. The term “weight-bearing dome” was used in this paper, although no specific anatomic or radiographic landmarks were defined. Dislocations of the femoral head were also described in this paper as central, posterior, and anterior. Outcome correlated with 1) involvement of the weight-bearing dome (roof), 2) femoral head condition, 3) adequacy of reduction of the dislocation (joint congruency), and 4) joint stability after one year. The authors classified the fractures as non-displaced, posterior, inner-wall, and superior or bursting fracture. In this study, they described their outcomes after both operative and non-operative treatment of 93 acetabular fractures with an average follow-up of six-years (range 1–27 years). Rowe and Lowell performed the first large study in 1961. In this article, they mention “ the primary objective, however, is reduction and fixation of the fractures which involve the weight-bearing vault (from 10 to 3 on the clock).” They determined that the results after open reduction were superior to “older” methods of manipulation and traction and felt long-term studies of a larger series of patients were warranted. In an effort to improve outcomes, they described surgical treatment of eight “central” acetabular fractures at the Campbell Clinic using Knowles pins. In 1958, Knight and Smith discussed the increasing frequency of acetabular fractures due to automobile accidents. The first larger case series was published by Okelberry in 1955 in which he performed internal fixation of seven acetabular fractures via an anterior iliofemoral approach. Urist described surgical fixation of an acetabular fracture via an anterior iliofemoral approach in 1949. ![]() In 1943, Levine fixed an acetabular fracture via the inner aspect of the ilium with plates and screws. The first outcomes published were case reports of acetabular fracture surgical fixation.
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