Ace Tabular Fractures

8/3/2019 Ace Tabular Fractures

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Radiology of acetabular fractures:

a simple approach

Dr stnAydngzDepartment of Radiology

Hacettepe University School of Medicine

Ankara, Turkey


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Pelvis: trauma projections

AP

Judet 1 (right iliac, left obturator)

Judet 2 (left iliac, right obturator)

Pelvic inlet

Pelvic outlet


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1.2 m

15


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Arcuate lines


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MVA. Ejected from vehicle.


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MVA. Ejected from vehicle.


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Another patient


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Another patient


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Another patient


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Fell from a height


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Fell from a height


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MVA


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MVA


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Iliopectineal line

Anterior column of the acetabulum


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Ilioischial line

Posterior column of the acetabulum


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Anterior wall

of the acetabulum


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Posterior wall

of the acetabulum


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Anterior wall

Posterior wall

Anterior

column

Posteriorcolumn


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Anterior wall

Posterior wall

Anterior column

Posterior column


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Anterior wall

Posterior wall

Anterior

column

Posteriorcolumn


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Judet (right) projection

= Left obturator projection

= Right iliac projection


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J u d e t - L e t o u r n e l c l a s s i f i c a t i o n o f

a c e t a b u l a r f r a c t u r e s


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O U T S I D E V I E W I N S I D E V I E W


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Anteriorcolumn

Posterior

column

Sciatic buttress


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Isolated

posterior wallfx

Transverse fxTransverse +

posteriorwall fx

T-shaped fxBoth column

fx


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Durkee et al. AJR 187:915925October 2006


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Acetabular fx identified

Obturator ring disruption?

Fracture extension to

the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx

T-shaped fx Transverse +

posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O


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1


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1


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1


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1


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O


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1


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POSTERIOR WALL FX

1


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1


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1


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2


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2


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2


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2


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2

A b l f id ifi d


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O


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POSTERIOR WALL FX

2


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2


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2


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3


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3


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3


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3 Acetabular fx identified


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O


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3


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TRANSVERSE +

POSTERIOR WALL FX

3


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3


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3


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3a


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3a


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3a


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3a


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3a


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TRANSVERSE +

POSTERIOR WALL FX

3a


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3a


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4


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4


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4


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4



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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O


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4


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4


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4


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4


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TRANSVERSE WITH

POSTERIOR WALL FX

4


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4


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4


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4


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4


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4


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4

5


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5

Jumped off a bridge, struck by a vehicle

5


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5

5


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5

5


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5



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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O

5


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BOTH COLUMN FX

5

5


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5

6


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6

ATK

6


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6

6


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6


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O U T S I D E V I E W I N S I D E V I E W

6


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6



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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O

6


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6

6


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6

6


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6

6


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6

6


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BOTH COLUMN FX

6

6


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6


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7


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MVA

7


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7


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7


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O

7


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7


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T-SHAPED FX

7


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7


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8


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O

8


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8


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9


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Fell from a tree 10 m

9


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9


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ANTERIOR WALL AND

POSTERIOR WALL FRACTURES


b i di i ?


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O

10


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10


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Obt t i di ti ?


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O

10


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10


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10


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10


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10


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10


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J u d e t - L e t o u r n e l c l a s s i f i c a t i o n o f

a c e t a b u l a r f r a c t u r e s


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the iliac wing?

Ilioischial and

iliopectineal lines

disrupted?

Posterior wall

fractured?

Posterior wall

fractured?

Both column

fx


posterior

wall fx

Transverse

fx

Isolated

posterior

wall fx

Y E S N O

Y E S N O Y E S

Y E S N O

Y E S N O

Radiology of acetabular fractures:


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a simple approach

Dr stnAydngz

Department of RadiologyHacettepe University School of Medicine

Ankara, Turkey

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Ace Tabular Fractures