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
  • Pelvic pain after trauma (low energy for elderly, high energy for young)

Differential Diagnosis

Hip pain

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
Right acetabular fracture (arrow)

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

References
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