Acetabular pelvic fractures
Background
- Fractures usually occur when head of femur forced into acetabulum
- Obvious when displaced, subtle non-displaced
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
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
Diagnosis
Radiographically
- 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