Acetabular pelvic fractures

Background

• Fractures usually occur when head of femur forced into acetabulum
• Obvious when displaced, subtle non-displaced

Pelvic fracture types

The skeleton of the human pelvis: 1. Sacrum; 2. Ilium; 3. Ischium; 4. Pubic bone (4a. corpus, 4b. ramus superior, 4c. ramus inferior, 4d. tuberculum pubicum); 5. Pubic symphysis, 6. Acetabulum (of the hip joint), 7. Foramen obturatum, 8. Coccyx/tailbone; Dotted. Linea terminalis of the pelvic brim.

Pelvis anatomy, medial view.

Pelvis anatomy, lateral view.

• Acetabular pelvic fractures
• Open book pelvic fracture
• Straddle pelvic fracture
• Pelvic avulsion fracture

Anatomy

Anatomy of the acetabulum.

• 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
      • Femoral head fracture
      • Femoral neck fracture
    • Extracapsular
      • Intertrochanteric femur fracture
      • Trochanteric femur fracture
  • Shaft
    • Mid-shaft femur fracture (all subtrochanteric)
• Hip dislocation
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture

Chronic/Atraumatic

• Hip bursitis
• Psoas abscess
• Piriformis syndrome
• Meralgia paresthetica
• Septic arthritis
  • Septic arthritis of the hip (peds)
• Obturator nerve entrapment
• Avascular necrosis of hip

Evaluation

Radiographically

Right acetabular fracture (arrow)

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
• 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

(Left) Anterior wall fracture, (right) anterior column fracture

(Left) Posterior wall fracture, (right) posterior column fracture

(Left) Posterior wall transverse fracture, (right) T-shaped fracture

• 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

See Also

• Pelvic fractures