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

• Femur fracture
• Hip dislocation
• Hip bursitis
• Psoas abscess
• Piriformis syndrome
• Meralgia paresthetica
• Septic Arthritis (Hip)
• Obturator nerve entrapment
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• 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

Authors

Kurt Hansen, Ross Donaldson, Michael O'Brien, MD, Jonathan Osgood, Eric Funk, Daniel Ostermayer, Neil Young