Acetabular fracture - anterior and posterior columns

Case contributed by Leonardo Lustosa

Presentation

Fall onto his right hip. Percussion of the right calcaneum was painful (positive anvil test).

Patient Data

Age: 70 years
Gender: Male

Pelvis radiograph revealed an acetabular fracture of the right hip consistent with anterior and posterior column fractures. Disruption of the iliopectineal and ilioischial lines, as well as of the acetabular roof are noted.

See annotated images below.

Some landmarks of the hip are compared on the right and left sides of the pelvis:

  • iliopectineal line - disruption indicates anterior column fracture
  • ilioischial line - disruption indicates posterior column fracture
  • acetabular roof

Case Discussion

Acetabular fractures aren't always as obvious as in the present case. Thus it is important to know an approach to their assessment.

Using the hip landmarks is a way to systematize and avoid missing more discrete findings.

The column concept is used to classify and guide the treatment approach of acetabular fractures. 

Also, it is of great importance to recognize if the acetabular roof is fractured.

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