0:01

So in this section we'll discuss the imaging approach

0:04

to acetabular fractures.

0:06

So in terms of the mechanism of injury

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for acetabular fractures, you can have fractures

0:12

of the posterior column

0:13

where the femoral head has become rotated internally,

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or fractures of the anterior column as a result

0:20

of the femoral head had been rotated externally.

0:25

When we go to think about acetabular fractures, there are

0:29

numerous types, about 10 types that have been described

0:32

with three main categories.

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So we can put them in the categories

0:36

of a predominantly transverse component,

0:39

column type fractures or wall type fractures.

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These are important because they're about 20%

0:45

of all pelvic fractures that present they may occur with

0:50

or without a hip dislocation,

0:52

and sometimes use special imaging techniques such

0:54

as the Judea projections to gain some insight

0:58

or CT imaging.

1:01

So shown here are the main categories of the fractures

1:05

and the different subtypes.

1:06

We have diagrams here with the orientation being

1:10

that we are looking at the acetabulum anteriors on the right

1:14

and posteriors on the left.

1:17

And so when we consider wall fractures, we can think of ones

1:20

that go through the posterior wall, ones

1:23

that involve the posterior column with the posterior wall,

1:27

ones that have a transverse component

1:29

with the posterior wall,

1:31

or ones that are isolated to the anterior wall.

1:35

Then we can consider column fractures.

1:37

So wall fractures involve that anterior

1:40

and posterior aspect of the acetabulum, whereas column

1:45

fractures go beyond the hip joint proper.

1:48

So we can have a posterior column fracture that goes

1:53

through the hip joint as well as the rest

1:55

of the posterior aspects of the iliac bone.

1:59

An anterior column fracture

2:01

that not only involves the anterior part of the acetabulum,

2:05

but through the iliac wing

2:07

and then into the isum, we can have a both column fracture

2:12

where there are components that go

2:13

through both the posterior column

2:16

and then continue through the anterior column.

2:21

You can have a posterior column with a posterior wall.

2:25

So now the wall of the acetabulum has its own fragment,

2:29

but there's an extension of the fracture

2:31

through the remainder of the posterior column,

2:34

anterior column with a posterior hemi transverse.

2:38

So here you have an anterior column extending

2:42

beyond the joint, but

2:44

with also a more transverse component going posterior.

2:48

And then we can have fractures that involve

2:51

a transverse component.

2:52

There's a T-shaped fracture.

2:54

So as you look at the acet tablum here, you can see

2:56

that there's a vertical component through

2:58

The the acetabulum. And

2:59

then this main transverse component

3:02

can have a transverse with a posterior wall,

3:05

a pure transverse fracture, an anterior column

3:09

with posterior hemi transverse.

3:12

And so as I've, as we've shown the fractures here, this

3:16

classification system, you can see

3:19

that there's some overlap.

3:20

So you'll see some of them listed that contain both column

3:23

and transverse fractures in both of those categories.

3:26

Just for the sake of categorization.

3:29

So as mentioned in the T tabular fractures,

3:31

there's three main categories, transverse column wall type,

3:35

but some of the fracture patterns can have overlap,

3:37

meaning they can be in more than one of those categories

3:40

as we just went through in the diagrams.