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Fractures of the Acetabulum

(see also: Pelvic Frx; Radiographs; Work Up and Treatment)

Classification and Column Theory »

elementary frx:

  • account for about 20% of acetabular frx;
  • anterior wall
  • anterior column:
    • bony strut running from ASIS to superior pubic ramus, & includes anterior wall;
    • iliopectineal line is involved;
  • transverse frx
    • involve both anterior & posterior acetabulum: dividing the innominate bone into superior segment containing acetabular roof & intact ilium, & inferior segment consisting of single ischiopubic fragment;
  • posterior wall
    • frxs always involve posterior articular surfaces, often accompanied by a portion ofretroacetabular surface and sometimesentire surface;
  • posterior column
    • bony strut running from PSIS to inferior pubic ramus, & includes posterior wall;
    • involves not only the posterior articular surfaces, but also the ilioischial line;

associated frx types:

  • account for about 80% of acetabular frx;
  • are composed of two or more of the elementary fracture patterns;
  • many assoc frx types, esp two-column frx, require more extensive exposures than are achieved by either ilioinguinal or posterolateral approach alone;

five patterns include:

  1. posterior column + posterior wall fractures
  2. transverse + posterior wall frx;
  3. anterior column + anterior wall plus associated w/ posterior hemitransverse fractures;
  4. T-shaped fracture;
  5. both column frx: this is the most common frx type (about 35% of acetabular frx);

References for Surgical Exposure

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