Flashcards in Acetabular Fractures Deck (18):
What are the elementary acetabular fractures?
1) Posterior wall ("gull sign")
2) Anterior wall (very rare)
3) Anterior column (elderly falls)
4) Posterior column (gluteal NVI)
5) Transverse (Axial CT shows ant. to post. fx line)
What are the associated acetabular fractures?
1) Post column, post wall
2) Trasverse, post wall (most common of assoc.)
4) Anterior column, post hemitransverse (elderly)
5) Both column fx ("spur sign")
A "gull sign" on an obturator oblique view is indicative of what type of acetabular fx?
Which elementary acetabular fx is the only one that involves both columns?
The posterior wall of the acetabulum is best visualized on which of the following radiographic views?
Which is the only associated acetabular fx that does not involve both columns?
Posterior column, posterior wall
What areas of the acetabulum are viewed with each Judet view?
Obtuator oblique- posterior wall, anterior column
iliac oblique- anterior wall, posterior column
What are the six landmarks of an AP pelvis when accessing for acetabular fractures?
1) iliopectineal line (anterior column)
2) ilioischial line (posterior column)
3) anterior wall
4) posterior wall
6) weight bearing dome (sourcil)
In a patient with a posterior acetabular wall fracture, what is the best method to evaluate the hip for stability?
Exam under anesthesia using fluoroscopy
Which acetabular fracture can be treated with WBAT for 6-8 weeks?
Posterior wall fx that is displaced 2mm)
posterior wall fracture involving > 40-50%
intra-articular loose bodies
pregnancy is not contraindication to surgical fixation
What factors correlate with improved outcomes in acetabular fractures?
1) Anatomical reduction (earlier operative intervention)
2) Reduction of hip dislocations within 12hrs
3) Hip muscle strength
4) Restoration of gait
In an elderly patient with an acute comminuted acetabular fracture what is an appropriate treatment option?
ORIF with acute THA
What are special Judet views used during percutaneous pelvic fixation?
Inlet iliac oblique- AP position of rami screw
Obturator oblique inlet- position of supra-acetabular screw within iliac tables
Obturator oblique outlet- joint penetration of screw
What approaches are available for acetabular fractures?
1) Anterior (ilioinguinal)- anterior wall or anterior column
2) Posterior (Kocher)- posterior wall, posterior column, transverse or T-shaped
3) Extensile (Iliofemoral)- fxs delayed >21 days, both column, T-shaped or transverse
4) Stoppa- quadrilateral plate,
What are risks involved with the various acetabular approaches?
1) Anterior (ilioinguinal)- LFCN, corona mortis (10-15%), femoral n.
2) Posterior (Kocher)- sciatic nerve (2-10%), MCFA
3) Extensile (Iliofemoral)- massive HO
4) Stoppa- must ligate corona mortis
The corona mortis artery joins the external illiac artery with which other major artery?
Inferior epigastric a.
Other branch is from obturator a.
A both column acetabular fracture is defined as what?
An acetabular fracture with all segments of the articular surface detached from the intact posterior ilium