Radiology of acetabular fractures: a simple approach

Dr stn Aydngz
Department of Radiology Hacettepe University School of Medicine Ankara, Turkey

Pelvis: trauma projections

AP
Judet 1 (right iliac, left obturator) Judet 2 (left iliac, right obturator)

Pelvic inlet Pelvic outlet

1.2 m

15

Arcuate lines

MVA. Ejected from vehicle.

MVA. Ejected from vehicle.

Another patient

Another patient

Another patient

Fell from a height

Fell from a height

MVA

MVA

Iliopectineal line
Anterior column of the acetabulum

Ilioischial line
Posterior column of the acetabulum

Anterior wall of the acetabulum

Posterior wall of the acetabulum

Anterior wall Posterior wall

Anterior column

Posterior column

Anterior wall Anterior column

Posterior wall

Posterior column

Anterior wall Posterior wall

Anterior column

Posterior column

Judet (right) projection

= Left obturator projection = Right iliac projection

Judet-Letournel classification of acetabular fractures

OUTSIDE VIEW

INSIDE VIEW

Sciatic buttress

Anterior column

Posterior column

Both column Transverse + T-shaped fx Isolated Transverse fx fx posterior posterior wall wall fx fx

Durkee et al. AJR 187:915925 October 2006

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

POSTERIOR WALL FX

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

POSTERIOR WALL FX

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

TRANSVERSE + POSTERIOR WALL FX

3a

3a

3a

3a

3a

TRANSVERSE + POSTERIOR WALL FX

3a

3a

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

TRANSVERSE WITH POSTERIOR WALL FX

Jumped off a bridge, struck by a vehicle

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

BOTH COLUMN FX

ATK

OUTSIDE VIEW

INSIDE VIEW

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

BOTH COLUMN FX

MVA

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

T-SHAPED FX

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

Fell from a tree 10 m

ANTERIOR WALL AND POSTERIOR WALL FRACTURES

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

10

10

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

10

10

10

10

10

10

Judet-Letournel classification of acetabular fractures

Acetabular fx identified
Obturator ring disruption?
YES NO

Fracture extension to the iliac wing?

YES NO

Ilioischial and iliopectineal lines disrupted?

YES NO

Posterior wall fractured?

YES NO

Posterior wall fractured?

YES

Both column fx

T-shaped fx

Transverse + posterior wall fx

Transverse fx

Isolated posterior wall fx

Radiology of acetabular fractures: a simple approach

Dr stn Aydngz
Department of Radiology Hacettepe University School of Medicine Ankara, Turkey