A 34-year-old woman sustains an acetabular fracture after a side impact. CT shows a minimally displaced posterior wall fragment. Roof arc angles measure 52 degrees on the AP view, 48 degrees on the obturator oblique, and 46 degrees on the iliac oblique. The hip is concentrically reduced and stable on stress examination under anesthesia. The best management is:
- A Nonoperative management with protected weight bearing and serial imaging ✓
- B Open reduction and internal fixation through a Kocher-Langenbeck approach
- C Skeletal traction for six weeks followed by bed rest
- D Total hip arthroplasty
Correct answer: A. Nonoperative management with protected weight bearing and serial imaging
Explanation
Roof arc angles of 45 degrees or greater on all three views indicate that the weight-bearing dome of the acetabulum is intact. Combined with a congruent, stable hip and a small fragment, this meets accepted criteria for nonoperative treatment with toe-touch weight bearing. Operative fixation would expose her to surgical risk without benefit, and arthroplasty is reserved for elderly patients with comminuted or impaction-dominated patterns.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.