0:01

In order to illustrate some acetabular fracture patterns,

0:05

I'm going to show you three companion cases.

0:08

So all of these cases are people that presented

0:10

after trauma with right sided hip pain,

0:13

and we're gonna go through our checklist approach.

0:15

So as we look at this pelvic radiograph here,

0:19

we can identify the iliac wings that appear intact.

0:23

The SI joints are not separated.

0:27

Pubic synthesis appears a little widen,

0:29

but that may be within normal hip joint

0:32

spaces are preserved.

0:34

And as we look at our acetabular lines,

0:37

again using the left compared to the right,

0:40

we follow along the ileal pectineal line here on the left

0:44

and ileal pectineal.

0:45

Here we see something that's a potential disruption,

0:50

but also it's

0:51

where the ileal pectineal line meets the ileal ischial line.

0:54

This lucency is asymmetric to the contralateral side

0:58

and it's at that confluence of the ileal issue

1:01

and ileal pectineal lines.

1:03

And so that looks abnormal.

1:05

The teardrop is preserved, the joint space is preserved

1:08

anterior and posterior walls are maintained.

1:13

So now we have a CT to confirm that that lucency

1:18

represents a fracture and a fracture is going

1:20

through the anterior part of the acetabulum here.

1:24

This is case number two again, right hip pain

1:27

after trauma here is our frontal projection,

1:30

and if we use our pelvic checklist approach, iliac wings

1:35

are intact, arcuate lines are maintained.

1:40

SI joints are not separated,

1:43

pubic synthesis is not diastat.

1:46

Hip joint spaces are preserved.

1:49

Going through the ileal issue,

1:52

an IAL pectineal line on the left, ileal pectineal

1:56

and ileal issu line on the right, those are maintained.

2:00

So if we check on the left side,

2:02

you can see the anterior wall.

2:06

It's maintained here. And then the posterior wall.

2:09

When we go to the contralateral side, it's hard

2:12

to visualize exactly where the anterior wall is.

2:16

And then the posterior wall line appears that there

2:19

may be a displaced fragment Here.

2:22

In this case, Judea projections were obtained.

2:26

So since we're focused on the right hip,

2:29

this is considered the iliac wing

2:32

view of the right side.

2:35

If we were concerned about left hip pathology,

2:38

it would be considered the opterator

2:41

ring view of the left side.

2:45

So looking at here on the right, we can see

2:47

that the acetabular roof is maintained

2:49

and the joint appears congruent and the the wing is intact.

2:54

Now our contralateral Judea view,

2:56

which again is 45 degrees and

2:58

Basically orthogonal to the other projection,

3:02

this becomes the opterator ring view of the right side

3:07

or iliac wing view of the left side.

3:11

So now with our opterator ring view of the right side,

3:14

we can see that the anterior column is maintained,

3:18

but posteriorly can appreciate lucency

3:22

through the posterior wall

3:24

and this OCI fragment here representing that finding

3:27

that we saw on the frontal projection.

3:30

So based on these, we're already suspicious

3:32

that there's a posterior wall injury

3:35

and the the CT confirms that fracture fragment

3:39

and posterior wall fracture on the right.

3:43

So here we have case number three,

3:45

and in this case there is an obvious abnormality

3:48

involving the right side.

3:50

So if we look at our left sided lines, ichi line

3:55

and IOP pectineal lines are maintained.

3:58

The teardrop is harder to to see

4:00

because there's a little bit of what's known as, uh,

4:03

protio or coa.

4:04

Profunda, a little bit of deepening of the socket,

4:06

which can be a normal variant.

4:08

But the anterior wall is maintained here

4:11

and you can see the posterior wall projected lateral.

4:14

All of that architecture is lost on the right side

4:18

because of this obvious fracture

4:20

that's now causing even more protrusion of the hip

4:23

and multiple fracture fragments.

4:26

Here we can identify fractures through the superior

4:29

and inferior ramus as well as going through the

4:33

iliac body here or the so-called supra acetabular region.

4:38

So now we are doing our iliac wing view on the right hip.

4:43

So again, right side. So we call this the iliac wing view.

4:46

For the right, the iliac wing is maintained.

4:49

You can see a fracture line going through that iliac body

4:51

and then producing this spike here.

4:54

And also a spike of bone projected medially as well

4:59

as displacement of the hip,

5:00

and then offset of the superior inferior pubic ray eye.

5:04

Just for the sake of completeness,

5:06

this would be the opterator ring view of the right hip,

5:10

which again appears normal.

5:12

And doing the contralateral Judea view,

5:15

we now have an opterator ring view of the right side

5:19

and which would be a considered iliac wing

5:21

view of the left side.

5:22

And on the right, this projection helps better depict the

5:26

displacement of the superior

5:28

and inferior pubic ram eye fractures.

5:31

And also produces an interesting finding here

5:35

of this prominent spur

5:37

that's projected off the lateral margin,

5:39

which we'll discuss in the subsequent section.