eMedicine Specialties > Radiology > Musculoskeletal
Acetabulum, Fractures: Multimedia
Updated: Feb 11, 2009
Multimedia
 | Media file 1: Lateral view of the left acetabulum. The left femur has been removed. The articular surface of the acetabulum is in the shape of an inverted horseshoe (outlined in red). The anterior column of the acetabulum includes most of the iliac wing, the anterior acetabulum, and the superior pubic ramus. The posterior column begins at the sciatic notch and includes the posterior portion of the acetabulum and the ischium. |
 | Media file 2: Anteroposterior view of the pelvis. The left femur has been removed for illustration purposes. The iliopectineal, or iliopubic, line is an important landmark for examining the anterior column of the acetabulum. The ilioischial line demarcates the medial border of the posterior column. The posterior wall of the acetabulum is larger and projects more laterally than does the anterior wall. |
 | Media file 3: Anteroposterior (AP) radiograph of the pelvis (compare with Image above). The iliopectineal (or iliopubic) and ilioischial lines serve as landmarks for the anterior and posterior columns, respectively. The larger and more lateral posterior wall is visualized more easily than is the smaller, more medial anterior wall. The acetabular tear figure is a composite shadow of the inferomedial structures that compose the acetabulum. The ilioischial line should pass through the teardrop on a true AP view of the pelvis. |
 | Media file 4: Left obturator oblique view of the pelvis. The left obturator ring is seen en face. The anterior column and posterior wall of the left acetabulum are profiled in this position. |
 | Media file 5: Left iliac oblique view of the pelvis. The left iliac wing is demonstrated en face. The left posterior column and the anterior wall are seen in profile. |
 | Media file 6: Acetabular fracture classification system. Judet and colleagues (1964) described the classification scheme that is most commonly used today. Of the 10 types, 5 are elementary fractures (top row), and 5 are associated fractures (bottom row). Elementary types involve 1 primary fracture plane. Associated types involve more than 1 fracture plane. |
 | Media file 7: Acetabular fracture orientation with a computed tomography (CT) scan. A CT scan of the left acetabulum obtained at the level of the dome shows that transverse-type acetabular fractures have a vertical (sagittal) orientation. Column-type fractures have a horizontal (coronal) orientation. |
 | Media file 8: Acetabular fracture orientation with a computed tomography (CT) scan. A CT scan of the left midacetabulum shows that wall fractures have an oblique orientation. |
 | Media file 9: Anterior wall acetabular fracture. A computed tomography (CT) scan demonstrates an oblique fracture through the anterior wall of the left acetabulum (arrow). Such fractures are uncommon in isolation. The patient had other pelvic injuries. |
 | Media file 10: Posterior wall acetabular fracture. Anteroposterior radiograph of the pelvis. The posterior wall of the left acetabulum is disrupted (arrow). |
 | Media file 11: Posterior wall acetabular fracture. A left obturator oblique radiograph of the pelvis. The posterior wall fracture (arrow) is better depicted on this view than on the anteroposterior view. |
 | Media file 12: Computed tomography (CT) scan of a posterior wall acetabular fracture. The oblique fracture of the left acetabulum is clearly depicted. The degree of displacement and marginal impaction can be determined more accurately with CT scanning than with radiography. |
 | Media file 13: Transverse with posterior wall acetabular fracture. An anteroposterior radiograph of the pelvis shows that the central dislocation of the left femoral head results in the disruption of the iliopectineal and ilioischial lines. In addition, the left posterior acetabular wall is disrupted. |
 | Media file 14: Transverse fracture with a posterior wall acetabular fracture. Compared with the anteroposterior view, this left obturator oblique view of the pelvis view better demonstrates the anterior column and posterior wall disruption. The obturator ring is intact. |
 | Media file 15: Computed tomography (CT) scan of a transverse fracture with a posterior wall acetabular fracture. The vertically oriented transverse fracture (arrow) of the left acetabulum is well depicted on CT scans. Note the oblique posterior wall fracture (arrowhead). Posterior wall fractures often are associated with femoral head dislocation. |
 | Media file 16: T-shaped acetabular fracture. An anteroposterior radiograph of the pelvis shows that a transverse fracture (arrows) disrupts the left iliopectineal and ilioischial lines. The obturator ring also is interrupted (arrowheads). No iliac wing fracture is seen above the level of the acetabulum. |
 | Media file 17: Computed tomography (CT) scan of T-shaped acetabular fracture. The transverse portion of the fracture has a vertical (sagittal) orientation (arrow). The extension of the fracture through the medial wall represents the stem of the T (arrowhead). More inferior CT scans demonstrated the obturator ring fractures. |
 | Media file 18: Posterior column acetabular fracture. An anteroposterior radiograph of the pelvis shows that the left femoral head is dislocated posteriorly. The ilioischial line is broken, but the iliopectineal line remains intact. |
 | Media file 19: Posterior column acetabular fracture. Compared with the anteroposterior view, the left obturator oblique radiograph of the pelvis better depicts the posteriorly displaced posterior column, posterior wall, and femoral head. |
 | Media file 20: Posterior column acetabular fracture. A left iliac oblique radiograph of the pelvis shows that the posterior column is markedly displaced. |
 | Media file 21: Computed tomography (CT) scan of a posterior column acetabular fracture at the level of the acetabular dome. The characteristic horizontal (coronal) orientation of the column fracture is appreciated easily by using CT scanning. |
 | Media file 22: Posterior column acetabular fracture. A computed tomography (CT) scan obtained at the level of the midacetabulum shows the horizontally oriented column fracture. The femoral head is relocated, but the recent posterior dislocation is evident in the anterior impaction fracture (arrow). |
 | Media file 23: Posterior column acetabular fracture. A computed tomography (CT) scan obtained at the level of the ischial tuberosities shows that posterior column fractures sometimes can exit through the ischial tuberosity (arrow) rather than through the obturator ring. |
 | Media file 24: Both-column acetabular fracture. An anteroposterior radiograph of the pelvis shows that the right ilioischial and iliopectineal lines are completely disrupted. A right iliac wing fracture is noted above the level of the acetabulum (arrow). A nondisplaced fracture of the right inferior pubic ramus is subtle. |
 | Media file 25: Both-column acetabular fracture. A right iliac oblique radiograph of the pelvis. The posterior column (arrowhead) and iliac wing disruptions are shown. |
 | Media file 26: Both-column acetabular fracture. A right obturator oblique radiograph of the pelvis best depicts nondisplaced fractures of the obturator ring (arrowheads). The iliopectineal line disruption (short arrow) signifies anterior column involvement. The pathognomonic spur sign (long arrow) of the both-column fracture is best appreciated on this view. The spur represents a strut of bone extending from the sacroiliac joint. The fracture of both columns disconnects this piece of bone from the acetabulum and causes its spurlike appearance. |
 | Media file 27: Both-column acetabular fracture. A computed tomography (CT) scan obtained at the level of the sacroiliac joints shows that the horizontal (coronal) column fracture begins superiorly at the iliac wing in the both-column fracture. The CT scan equivalent of the spur sign can be seen (arrow). |
 | Media file 28: Both-column acetabular fracture. A computed tomography (CT) scan obtained just above the level of the acetabular dome shows that the CT scan spur sign is present (arrow). |
 | Media file 29: Both-column acetabular fracture. A computed tomography (CT) scan obtained at the level of the acetabular dome shows the CT scan spur sign (arrow). Note how this spur does not connect to the articular portion of the acetabulum. In a both-column fracture, the articular surface of the acetabulum is completely disconnected from the axial skeleton. |
 | Media file 30: Anterior column fracture with a posterior hemitransverse acetabular fracture. An anteroposterior radiograph of the pelvis shows disruption of the iliopectineal (long arrow) and ilioischial (short arrows) lines. The obturator ring is intact. |
 | Media file 31: Anterior column fracture with a posterior hemitransverse acetabular fracture, as depicted on computed tomography (CT) scans obtained above and at the level of the right acetabulum. Left: The image shows an iliac wing fracture (arrow) that was not appreciated on the anteroposterior radiograph. (The oblique radiographs were not of good quality.) Middle: The image clearly depicts a column-type fracture (arrow) that is oriented horizontally on the CT scans. Right: The image again demonstrates the column fracture (long arrow), but now a transverse (vertically oriented) fracture can be seen posteriorly (short arrow). |
More on Acetabulum, Fractures |
| Overview: Acetabulum, Fractures |
| Imaging: Acetabulum, Fractures |
 Multimedia: Acetabulum, Fractures |
| References |
| Further Reading |
| « Previous Page |
References
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Olson SA. CT-based acetabular fracture classification. AJR Am J Roentgenol. Jul 2005;185(1):277-8; author reply 278-80. [Medline]. [Full Text].
Lovric I, Jovanovic S, Leksan I, et al. Functional status of hip joint after surgical and conservative treatment of acetabular fracture. Coll Antropol. Mar 2007;31(1):285-9. [Medline].
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[Best Evidence] Karunakar MA, Sen A, Bosse MJ, et al. Indometacin as prophylaxis for heterotopic ossification after the operative treatment of fractures of the acetabulum. J Bone Joint Surg Br. Dec 2006;88(12):1613-7. [Medline].
Harris JH Jr, Lee JS, Coupe KJ, et al. Acetabular fractures revisited: part 1, redefinition of the Letournel anterior column. AJR Am J Roentgenol. Jun 2004;182(6):1363-6. [Medline]. [Full Text].
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Tile M. Fractures of the acetabulum. In: Rockwood CA, Green DP, Bucholz RW, et al, eds. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; Lippincott-Raven Pub:1996.
Brandser EA, El-Khoury GY, Marsh JL. Acetabular fractures: a systematic approach to classification. Emerg Radiol. 1995;2:18-28.
Borrelli J Jr, Peelle M, McFarland E, Evanoff B, Ricci WM. Computer-reconstructed radiographs are as good as plain radiographs for assessment of acetabular fractures. Am J Orthop. Sep 2008;37(9):455-9; discussion 460. [Medline].
Citak M, Gardner MJ, Kendoff D, Tarte S, Krettek C, Nolte LP, et al. Virtual 3D planning of acetabular fracture reduction. J Orthop Res. Apr 2008;26(4):547-52. [Medline].
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Harris JH Jr, Coupe KJ, Lee JS, Trotscher T. Acetabular fractures revisited: part 2, a new CT-based classification. AJR Am J Roentgenol. Jun 2004;182(6):1367-75. [Medline].
Ohashi K, El-Khoury GY, Abu-Zahra KW, Berbaum KS. Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary?. Radiology. Nov 2006;241(2):386-91. [Medline].
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Further Reading
Clinical Guidelines and Trials:
ACR Appropriateness Criteria® developmental dysplasia of the hip. American College of Radiology - Medical Specialty Society. 1999 (revised 2005). 8 pages. NGC:004788
ACR Appropriateness Criteria® imaging after total hip arthroplasty (THA). American College of Radiology - Medical Specialty Society. 1998 (revised 2005). 8 pages. NGC:004649
Periacetabular Osteotomy.A Prospective Study With Reference to Cartilage, Migration and Bone Density
Role of Vacuum Assisted Closure (VAC) Device in Postoperative Management of Pelvic and Acetabular Fractures
Unipolar or Bipolar Hemiarthroplasty in the Treatment of Displaced Femoral Neck Fractures. A Randomized Trial of RSA Measurements of Acetabular Wear
Acetabular Fractures of Both Columns
A Clinical Investigation of the C2a-Taper™ Acetabular System
Clinical Study Evaluating an Acetabular Cup System After Total Hip Replacement
Safety and Effectiveness Study of the Reflection Ceramic Acetabular System
The Influence of "Operating Table Position Simulating Radiographs" on Acetabular Cup Angle During Primary Total Hip Replacement
Evaluation of Acetabular Perfusion After Ganz Osteotomy by Positron Emission Tomography
Keywords
acetabulum fracture, acetabulum trauma, acetabular trauma, femur trauma, femoral trauma
