Review Question - QID 8229

The radiograph and CT scan show a posterior hip dislocation with an associated posterior wall acetabular fracture. The next step in management is assessment of hip instability. As suggested by Tornetta, assessment of hip instability with dynamic stress views is helpful to determine which posterior wall fractures are unstable and therefore require open reduction and internal fixation. Although protected weight bearing may be correct if the hip is stable, stability needs to be determined first. The CT scan reveals a small fragment in the cotyloid fossa. However, in this location, the presence of a loose body alone does not require surgical treatment. Hip instability needs to be assessed before determining if this fracture should be treated with open reduction and internal fixation. Total hip arthroplasty is not appropriate for a 24-year-old patient with a small posterior wall acetabular fracture.