BACKGROUND
Despite advances in surgical techniques and increased clinical experience, displaced acetabular fractures present a significant challenge for the orthopedist. The current gold standard for treatment is an open reduction and internal fixation. However, significant complications such as post-traumatic osteoarthritis and avascular necrosis of the femoral head persist. In such cases the effective solution is total hip arthroplasty.
Four cases were treated with a single-stage open reduction with a total hip arthroplasty, and the available literature on this topic was analyzed.
CASE REPORT
Four cases with acetabular fractures were managed. They were classified using the Letournel classification. Postoperative assessment was done via a clinical evaluation, and a Harris Hip Score instrument. Case reports are presented for 4 patients: 1 aged 25 years, 1 aged 67 years, and 2 aged 70 years. The mean body mass index was 29.4 kg/m². A Kocher-Langenbeck approach was mainly utilized in all the patients. The follow-up period was 27, 49, 22, and 122 months, respectively. The Harris Hip scores at the final follow-up were 87, 92, 80, and 85 points, respectively.
CONCLUSIONS
Open reduction and internal fixation alone remains the gold standard for displaced acetabular fractures. However, in selected older patients or those with fracture patterns carrying a high risk of avascular necrosis or post-traumatic osteoarthritis, single-stage open reduction or reconstruction with total hip arthroplasty appears feasible and may avoid the need for secondary arthroplasty. Larger comparative studies are needed to define optimal patient selection.

Keywords: Acetabulum; Fracture Fixation; Hip Prosthesis; Osteonecrosis