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

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

• 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

• 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

References

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