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Review Question - QID 4861

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QID 4861 (Type "4861" in App Search)
A 27-year-old man falls off of a bicycle at a high speed and is taken to the emergency department, where he is diagnosed with an acetabular fracture. Which of the following image sets accurately depicts a fracture that involves only one of the two columns of the acetabulum?
  • A
  • B
  • C
  • D
  • E

Figure A

18%

1118/6361

Figure B

6%

368/6361

Figure C

19%

1184/6361

Figure D

47%

3018/6361

Figure E

10%

620/6361

  • A
  • B
  • C
  • D
  • E

Select Answer to see Preferred Response

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Figure D represents an associated posterior column and posterior wall fracture while the other four choices are consist of fractures that incorporate both the anterior and posterior columns.

The transverse family of acetabulum fractures includes the elementary transverse pattern as well as associated transverse and posterior wall and T-type patterns. All transverse fractures disrupt both structural columns of the acetabulum by separating the hemipelvis from cranial to caudal. Of note, this is represented on axial CT cuts by a vertically-oriented fracture line. Conversely, columnar fracture patterns can include either one or both of the columns, and they separate the anterior and/or posterior column from the rest of the hemipelvis. In contrast to transverse fracture lines, this is represented on axial CT cuts by a horizontal fracture line, but is often best seen on judet views or 3d CT scans.

Matta reported on his outcomes of 263 displaced acetabulum fractures treated with open reduction and internal fixation within 21 days of injury. He reported excellent or good function in 76% of patients, which correlated well to quality of reduction of the joint surface seen on follow up radiographs.

Borrelli et al. reported that computer-reconstructed radiographs are equal to standard pelvic radiographs for assessing acetabulum fracture patterns.

Beaulé, Dorey, and Matta analyzed the interobserver reliability of Letournel's classification system using both pelvic radiographs and CT imaging. They found that while CT scans add valuable information regarding articular impaction and intraarticular loose bodies, CT data did not significantly increase the interobserver reliability of Letournel's classification.

The associated posterior column and posterior wall fracture depicted in Figure D displays an intact anterior column on both x-ray and axial CT. The axial CT also illustrates the horizontal nature of the posterior column fracture line.

Illustration A shows the 5 elementary and 5 associated fracture patterns as described by Letournel.

Incorrect Answers:
Answer 1: Figure A shows reconstructed CT scans with a vertical fracture line clearly in the iliac wing which is part of the anterior column. The CT also shows involvement of the posterior column with a transverse fracture line. The X-ray demonstrates a "spur sign", which is pathonemonic for an associated both column fracture.

Answer 2: Figure B X-ray sows disruption of both the Ilio-pectineal and Ilio-ischial lines which demonstrates disruption of the anterior and posterior columns respectively. The CT cut show a vertically oriented fracture line consistent with a transverse fracture. The reconstructed CT confirms the transverse fracture with addition of a posterior wall fracture.

Answer 3: Figure C, the AP pelvis X-ray shows a subtle line extending into both the Ilio-pectineal and Ilio-ischial lines. Along with a CT cut showing a vertically oriented fracture line consistent with a transverse fracture as well as a separate posterior wall fragment.

Answer 5: Figure E shows an obturator oblique Judet view, which show disruption of the ilio-pectinial line (anterior column) with the CT again showing a vertically oriented fracture line consistent with a transverse fracture as well as a separate posterior wall fragment.

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