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Assigning Day's classification to a given case can be difficult in up to 33% patients with crescent fractures due to the obliquity of the iliac fracture line in axial sections. Sacroiliac articular alignment is the primary factor determining the surgical approach. Besides the fracture configuration, additional factors like delay in surgery, locking of the fracture fragments, comminution of the iliac or sacral fragment as well as access to the additional injuries contribute to the decision making.

The incidence of periprosthetic distal femoral fractures after total knee replacement has been reported to be in the range of 0.3% to 2.5%. The treatment is technically challenging in fractures with small osteopenic distal fragment that might compromise stable fixation. Proper alignment and stabilization of the fracture is mandatory for early mobilization of the knee. Through the previous midline scar, knee is approached and with minimal soft tissue dissection a 7 or 9 mm supracondylar intramedullary nail is inserted retrograde achieving reduction and temporary stability. To augment the fixation, a distal femoral locking plate is slid submuscular by minimal invasive technique and held with screws. When possible, the nail locking screws are inserted through the plate, achieving stable reduction and adequate fixation to allow early mobilization during the postoperative period. Between 2009 and 2015, 13 patients with 14 type-2 periprosthetic supracondylar fractures were operated with the hybrid fixation technique. All the patients achieved union at 3 months with no loss of alignment or loss of range of motion. In type-2 supracondylar fractures with marked comminution, osteopenia, and small distal fragment, the hybrid fixation technique achieves satisfactory reduction and adequate stabilization that helps in early mobilization and fracture healing without additional periosteal damage to the distal fragment.

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This study reports a rare case of both column acetabulum fracture with femoral artery injury that presented late and was managed with arterial reconstruction and fracture fixation.A thirty-one year old man sustained both column acetabular fracture on the left in a motor vehicle accident. On admission there was no obvious neuro-vascular deficit. During surgery for the fracture after 7 days of the injury the femoral artery was found to be severely crushed with no blood flow. The anterior column of the acetabulum was stabilised followed by resection and reconstruction of the femoral artery. The post-operative period was uneventful and he was discharged normally. At 6 months from injury the fractures had united well with excellent limb circulation and good lower limb function.Femoral artery injury with acetabular fracture is rare and late presentations are unreported hitherto. The results of fracture stabilisation and vessel reconstruction seem to be excellent. Literature of similar injuries is reviewed.