Acetabular fracture
Acetabular fractures are a type of pelvic fracture, which may also involve the ilium, ischium or pubis depending on fracture configuration.
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Epidemiology
Acetabular fractures are uncommon. The reported incidence is approximately 3 per 100,000 per year. This study reported a 63% to 37% male to female ratio 1.
Pathology
Mechanism
- high-energy trauma: axial loading of the femur
- fall from height
- motor vehicle collision
- crush injury
- low-energy trauma with abnormal bone: insufficiency fracture
Classification
The Judet and Letournel system for acetabular fractures is the most widely used classification system in clinical practice. It classifies fracture based on oblique pelvic view on plain radiographs.
Additional classification systems include:
- Orthopedic Trauma Association classification (primarily for research) 3
- Harris system (CT imaging based) 4,5
Radiographic features
Plain radiograph
Initial assessment is often with a portable AP radiograph of the pelvis in the emergency department.
Assess the following lines:
- anterior acetabular wall
- posterior acetabular wall
- acetabular roof
- iliopectineal line: disrupted in fractures involving the anterior column
- ilioischial line: disrupted in fractures involving the posterior column
- radiographic U (teardrop)
After diagnosis, oblique pelvic views (Judet views) may be used for follow up. These include:
- iliac oblique view for the posterior pelvic column and anterior acetabular wall
- obturator oblique view for the anterior pelvic column and posterior acetabular wall
CT
CT has revolutionised the diagnosis, enabling precise delineation of the fracture configuration and assessment of any articular surface disruption.
Many patients with high-energy trauma will have a whole body CT, allowing initial assessment of the femoroacetabular joint as well as any other injuries that are likely to be present, given the typically high energy mechanism of injury 2.
For those patients with pelvic insufficiency fractures involving the acetabulum, a standard CT with a bony algorithm may be useful, especially if operative management is under consideration.
A repeat CT after traction is sometimes used to assess response to treatment.
Treatment and prognosis
Treatment
- analgesia
- venous thromboembolism prophylaxis
- traction
- skin traction
- skeletal traction
- non-operative management 6
- may be indicated in the setting of minimally displaced fracture
- more common in developing countries
-
open reduction and internal fixation (ORIF) 7
- articular incongruence/displaced fracture
- significantly distorted acetabular roof arc
- entrapped intra-articular fragment
- subluxation of the femoral head
Complications
- deep vein thrombosis
- post-traumatic osteoarthritis
Related articles
Related Radiopaedia articles
Fractures
-
fracture
- terminology
- fracture location
- diaphyseal fracture
- metaphyseal fracture
- physeal fracture
- epiphyseal fracture
- fracture types
- avulsion fracture
- articular surface injuries
- complete fracture
- incomplete fracture
- infraction
- compound fracture
- pathological fracture
- stress fracture
- fracture displacement
- fracture location
- fracture healing
- skull fractures
-
facial fractures
- fractures involving a single facial buttress
- alveolar process fractures
- frontal sinus fracture
- isolated zygomatic arch fractures
- mandibular fracture
- nasal bone fracture
- orbital blow-out fracture
- paranasal sinus fractures
- complex fractures
- dental fractures
- fractures involving a single facial buttress
-
spinal fractures
- classification (AO Spine classification systems)
-
cervical spine fracture classification systems
- AO classification of upper cervical injuries
- AO classification of subaxial injuries
- Anderson and D'Alonzo classification (odontoid fracture)
- Roy-Camille classification (odontoid process fracture)
- Levine and Edwards classification (hangman fracture)
- Allen and Ferguson classification (subaxial spine injuries)
- subaxial cervical spine injury classification (SLIC)
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
- classification of sacral fractures
-
cervical spine fracture classification systems
- spinal fractures by region
- spinal fracture types
- classification (AO Spine classification systems)
- rib fractures
- sternal fractures
-
upper limb fractures
- classification
- Rockwood classification (acromioclavicular joint injury)
- AO classification (clavicle fracture)
- Neer classification (clavicle fracture)
- Neer classification (proximal humeral fracture)
- AO classification (proximal humeral fracture)
- AO/OTA classification of distal humeral fractures
- Milch classification (lateral humeral condyle fracture)
- Weiss classification (lateral humeral condyle fracture)
- Bado classification of Monteggia fracture-dislocations (radius-ulna)
- Mason classification (radial head fracture)
- Frykman classification (distal radial fracture)
- Mayo classification (scaphoid fracture)
- Hintermann classification (gamekeeper's thumb)
- Eaton classification (volar plate avulsion injury)
- Keifhaber-Stern classification (volar plate avulsion injury)
- upper limb fractures by region
- shoulder
- clavicular fracture
-
scapular fracture
- acromion fracture
- coracoid process fracture
- glenoid fracture
- humeral head fracture
- proximal humeral fracture
- humeral neck fracture
- arm
- elbow
- forearm
- wrist
-
carpal bones
- scaphoid fracture
- lunate fracture
- capitate fracture
- triquetral fracture
- pisiform fracture
- hamate fracture
- trapezoid fracture
- trapezium fracture
- hand
- shoulder
- classification
- lower limb fractures
- classification by region
- pelvis
- hip
- Pipkin classification (femoral head fracture)
- Garden classification (hip fracture)
- American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture)
- Cooke and Newman classification (periprosthetic hip fracture)
- Johansson classification (periprosthetic hip fracture)
- Vancouver classification (periprosthetic hip fracture)
- femoral
- knee
- Schatzker classification (tibial plateau fracture)
- Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture)
- tibia/fibula
- Watson-Jones classification (tibial tuberosity avulsion fracture)
- ankle
- foot
- Berndt and Harty classification (osteochondral lesions of the talus)
- Sanders CT classification (calcaneal fracture)
- Hawkins classification (talar neck fracture)
- Myerson classification (Lisfranc injury)
- Nunley-Vertullo classification (Lisfranc injury)
- pelvis and lower limb fractures by region
- pelvic fracture
- sacral fracture
- coccygeal fracture
-
hip
- acetabular fracture
- femoral head fracture
-
femoral neck fracture
- subcapital fracture
- transcervical fracture
- basicervical fracture
-
trochanteric fracture
- pertrochanteric fracture
- intertrochanteric fracture
- subtrochanteric fracture
- thigh
- mid-shaft fracture
- bisphosphonate-related fracture
- knee
- avulsion fractures
- Segond fracture
- reverse Segond fracture
- anterior cruciate ligament avulsion fracture
- posterior cruciate ligament avulsion fracture
- arcuate complex avulsion fracture (arcuate sign)
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- semimembranosus tendon avulsion fracture
- Stieda fracture (MCL avulsion fracture)
- patellar fracture
- tibial plateau fracture
- avulsion fractures
- leg
- tibial tuberosity avulsion fracture
- tibial shaft fracture
- fibular shaft fracture
- Maisonneuve fracture
- ankle
- foot
- tarsal bones
- metatarsal bones
- phalanges
- classification by region
- terminology