Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Left obturator oblique inlet
2%
42/1712
Right iliac oblique
3%
44/1712
Left obturator oblique
11%
191/1712
Left iliac oblique
82%
1400/1712
Right iliac oblique outlet
1%
19/1712
Select Answer to see Preferred Response
The patient has sustained a left anterior column posterior hemi-transverse acetabulum fracture. In order to properly visualize the LEFT posterior column, the most optimal radiographic Judet views would be a left iliac oblique or a right obturator oblique (these are the same image). Acetabulum fractures are classified into 5 elementary (posterior wall, posterior column, anterior wall, anterior column, and transverse) and 5 associated fractures (associated both columns, anterior column posterior hemi-transverse, posterior wall posterior column, T-type, transverse posterior wall) patterns. Judet radiographs are very helpful in showing the extent of column and wall involvement in acetabulum fractures. These x-rays are 45-degree obliques of the hip in question and they show the profile of the obturator foramen (obturator oblique) and iliac wing (iliac oblique). To visualize the posterior column (and anterior wall), one would order the ipsilateral iliac oblique (which is equivalent to the contralateral side obturator oblique). On the contrary, the obturator oblique (and contralateral side iliac oblique) would be used to visualize the anterior column and posterior wall. Martin et al. performed a retrospective review of 133 patients who underwent acetabular revision arthroplasty for pelvic discontinuity (PD) to determine the radiographic views that allowed for the most optimal visualization of the PD. They noted that using only an AP pelvis view, 87% of PDs were picked up while using only a lateral hip and only Judet views, 49% and 77% of PDs were noted, respectively. The authors concluded a combination of an AP pelvis radiograph, plus a true lateral radiograph of the hip, plus Judet films allowed for the identification of PD in 100% of patients. Abdel et al. evaluated the imaging characteristics and treatment of PD. They define PD as a separation of the ilium superiorly from the ischiopubic segment inferiorly. They site the importance of obtaining appropriate imaging including plain hip radiographs, oblique Judet radiographs, and often a CT scan. The others go on to describe various treatment modalities for managing this challenging problem including a hemispheric acetabular component with posterior column plating, a cup-cage construct, pelvic distraction, and a custom triflange construct. Figure A is an AP pelvis showing a left anterior column posterior hemi-transverse acetabulum fracture. Illustration A is an obturator oblique radiograph of the patient in Figure A showing an anterior column fracture. Illustration B and C are Iliac oblique radiographs showing the posterior column of the same patient. Incorrect Answers: Answer 1 and 3: A left obturator oblique radiograph would be helpful in visualizing the left anterior column and left posterior wall. Inlet and outlet views in the same obliquity would still allow visualization of those areas. Answer 2 and 5: A right iliac oblique radiograph would be helpful in visualizing the left anterior column and left posterior wall. Inlet and outlet views in the same obliquity would still allow visualization of those areas.
3.3
(6)
Please Login to add comment