Acetabular pelvic fractures: Difference between revisions
No edit summary |
|||
(4 intermediate revisions by the same user not shown) | |||
Line 2: | Line 2: | ||
*Fractures usually occur when head of femur forced into acetabulum | *Fractures usually occur when head of femur forced into acetabulum | ||
*Obvious when displaced, subtle non-displaced | *Obvious when displaced, subtle non-displaced | ||
{{Pelvic fracture types}} | |||
===Anatomy=== | ===Anatomy=== | ||
[[File:Gray235.png|thumb|Anatomy of the acetabulum.]] | |||
*Anterior column-anterior acetabulum to pubic ramus | *Anterior column-anterior acetabulum to pubic ramus | ||
*Posterior column- posterior acetabulum to ischial ramus | *Posterior column- posterior acetabulum to ischial ramus | ||
Line 17: | Line 20: | ||
==Evaluation== | ==Evaluation== | ||
===Radiographically=== | ===Radiographically=== | ||
[[File:Acetabularfx.png|thumb|alt=Acetabular fracture (red arrow)|Right acetabular fracture (arrow)]] | [[File:Acetabularfx.png|thumb|alt=Acetabular fracture (red arrow)|Right acetabular fracture (arrow)]] | ||
[[File:Acetabular Fracture CT.png|thumb|Axial CT image (viewed on bone windows) of a complex comminuted left acetabular fracture involving both anterior and posterior columns.]] | |||
*Consider obtaining AP, Judet, and inlet/outlet films | *Consider obtaining AP, Judet, and inlet/outlet films | ||
*Iliopubic line extends from ilium to superior pubic ramus | *Iliopubic line extends from ilium to superior pubic ramus |
Latest revision as of 22:52, 17 March 2021
Background
- Fractures usually occur when head of femur forced into acetabulum
- Obvious when displaced, subtle non-displaced
Pelvic fracture types
- Acetabular pelvic fractures
- Open book pelvic fracture
- Straddle pelvic fracture
- Pelvic avulsion fracture
Anatomy
- Anterior column-anterior acetabulum to pubic ramus
- Posterior column- posterior acetabulum to ischial ramus
- Anterior and posterior columns merge to form acetabular dome= weight bearing portion
- Fractures involving acetabular dome require operative fixation
Clinical Features
- Pelvic pain after trauma (low energy for elderly, high energy for young)
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
Radiographically
- Consider obtaining AP, Judet, and inlet/outlet films
- Iliopubic line extends from ilium to superior pubic ramus
- Ilioischial line- extends from ilium to ischial ramus forming radiographic teardrop, "U" shaped, on AP pelvis
- Quadrilateral plate forms medial wall of acetabulum
Fractures Types
- Anterior column
- Posterior column
- Transverse
- T or Y-shaped
- Posterior rim
- Anterior Wall
Management
- Early ortho consultation and hospital admission is indicated for all
Disposition
- Admission