Acetabulum Fractures

Question 0

What does the ANTERIOR Colum consist of?

Answer 0

ANTERIOR ILIUM- Gluteus medius tubercle
ANT WALL and DOME
ILIOPECTINEAL EMINENCE
LATERAL SUPERIOR PUBIC RAMUS

Question 1

What does the posterior column consist of?

Answer 1

QUADRILATERAL SPACE
POST WALL & DOME
ISCHIAL TUBEROSITY
GREATER / LESSER SCIATIC NOTCHES

Question 2

What is the blood supply around the pelvis ? When is this structure at risk?

Answer 2

The anastomosis between the inferior epigastric ( from ext iliac- and OBTURATOR vessels ( from int iliac - thru OBTURATOR foremen ) known as the CORONA MORTIS
At risk - lateral dissection over Superior public ramus

Question 3

What is the classification of ACETABULAR Fractures?

Answer 3

LETOURNEL
2 major groups
ELEMENTARY
ASSOCIATED

Question 4

Can you describe the elementary groups

Answer 4

POSTERIOR WALL
POSTERIOR COLUMN- ILIOSCHIAL LINE DISRUPTED, Iliopectional intact. Iliac oblique view shows disruption of ILIOSCHIAL line.Check for injury to SUP GLUTEAL NV bundle
ANTERIOR WALL- common in elderly after fall
ANTERIOR COLUMN
TRANSVERSE- transverse # across acetabulum

Question 5

Can you describe the Associated groups?

Answer 5

Associated BOTH COLUMNS- dissociation of ARTICULAR surface w INOMINATE BONE- disruption of Iliopectional line( ant column) and ILIOSCHIAL ( post column). Spur sign seen on OBTURATOR view

POST COLUMN & POST WALL- only assoc # that doesn’t involve both columns

TRANSVERSE & POST WALL- most common assoc #

T SHAPED- may need combined approach

ANT COLUMN & POST HEMITRANSVERSE- common elderly

Question 6

What are the 6 radiographic landmarks of the acetabulum?

Answer 6

Iliopectional line- anterior colum
ILIOSCHIAL line- posterior column
Anterior rim
Posterior rim
Teardrop
Weight bearing roof

Question 7

What X-rays help you identify an acetabulum fracture?

Answer 7

Judet view- 45 degree oblique views
OBTURATOR OBLIQUE- shows Anterior column & Post wall
OBTURATOR foramen
ILIAC OBLIQUE- profile of iliac wing
Shows POST column, ANT wall

Question 8

Suggest another investigation for assessment of an acetabulum fracture and why important ?

Answer 8

CT
Define fragment SIZE and ORIENTATION
Identify MARGINAL IMPACTION
Identify LOOSE BODIES
Look for ARTICULAR GAP/ step off

Question 9

Describe the treatment for acetabular fractures ?

Answer 9

For MINIMALLY DISPLACED # < 20% POST WALL #
Femoral head CONGRUENT w weight bearing roof
Displaced # w roof arcs >45 degrees on ap / Judet view
Relative CI to surgery- morbid obesity
Open contaminated wound
Presence of DVT