Acetabular Fractures

Question 1

What are the elementary acetabular fractures?

Answer 1

1) Posterior wall (“gull sign”)
2) Anterior wall (very rare)
3) Anterior column (elderly falls)
4) Posterior column (gluteal NVI)
5) Transverse (Axial CT shows ant. to post. fx line)

Question 2

What are the associated acetabular fractures?

Answer 2

1) Post column, post wall
2) Trasverse, post wall (most common of assoc.)
3) T-shaped
4) Anterior column, post hemitransverse (elderly)
5) Both column fx (“spur sign”)

Question 3

A “gull sign” on an obturator oblique view is indicative of what type of acetabular fx?

Answer 3

Posterior wall

Question 4

Which elementary acetabular fx is the only one that involves both columns?

Answer 4

Transverse

Question 5

The posterior wall of the acetabulum is best visualized on which of the following radiographic views?

Answer 5

Obturator oblique

Question 6

Which is the only associated acetabular fx that does not involve both columns?

Answer 6

Posterior column, posterior wall

Question 7

What areas of the acetabulum are viewed with each Judet view?

Answer 7

IOWA
Obtuator oblique- posterior wall, anterior column
iliac oblique- anterior wall, posterior column

Question 8

What are the six landmarks of an AP pelvis when accessing for acetabular fractures?

Answer 8

1) iliopectineal line (anterior column)
2) ilioischial line (posterior column)
3) anterior wall
4) posterior wall
5) teardrop
6) weight bearing dome (sourcil)

Question 9

In a patient with a posterior acetabular wall fracture, what is the best method to evaluate the hip for stability?

Answer 9

Exam under anesthesia using fluoroscopy

Question 10

Which acetabular fracture can be treated with WBAT for 6-8 weeks?

Answer 10

Posterior wall fx that is displaced 2mm)
posterior wall fracture involving > 40-50%
marginal impaction
intra-articular loose bodies
irreducible fracture-dislocation
pregnancy is not contraindication to surgical fixation

Question 11

What factors correlate with improved outcomes in acetabular fractures?

Answer 11

1) Anatomical reduction (earlier operative intervention)
2) Reduction of hip dislocations within 12hrs
3) Hip muscle strength
4) Restoration of gait
5) Age

Question 12

In an elderly patient with an acute comminuted acetabular fracture what is an appropriate treatment option?

Answer 12

ORIF with acute THA

Question 13

What are special Judet views used during percutaneous pelvic fixation?

Answer 13

Inlet iliac oblique- AP position of rami screw
Obturator oblique inlet- position of supra-acetabular screw within iliac tables
Obturator oblique outlet- joint penetration of screw

Question 14

What approaches are available for acetabular fractures?

Answer 14

1) Anterior (ilioinguinal)- anterior wall or anterior column
2) Posterior (Kocher)- posterior wall, posterior column, transverse or T-shaped
3) Extensile (Iliofemoral)- fxs delayed >21 days, both column, T-shaped or transverse
4) Stoppa- quadrilateral plate,

Question 15

What are risks involved with the various acetabular approaches?

Answer 15

1) Anterior (ilioinguinal)- LFCN, corona mortis (10-15%), femoral n.
2) Posterior (Kocher)- sciatic nerve (2-10%), MCFA
3) Extensile (Iliofemoral)- massive HO
4) Stoppa- must ligate corona mortis

Question 16

The corona mortis artery joins the external illiac artery with which other major artery?

Answer 16

Inferior epigastric a.

Other branch is from obturator a.

Question 17

A both column acetabular fracture is defined as what?

Answer 17

An acetabular fracture with all segments of the articular surface detached from the intact posterior ilium

Question 18

What position of the leg exerts the least amount of intraneural pressure on the sciatic nerve?

Answer 18

hip extension, knee flexion