Updated: 9/7/2021

Acetabular Fractures

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  • Summary
    • Acetabulum fractures are pelvis fractures that involve the articular surface of the hip joint and may involve one or two columns, one or two walls, or the roof within the pelvis.
    • Diagnosis can be made radiographically with dedicated pelvis radiographs (including Judet views) but frequently require CT pelvis for surgical planning.
    • Treatment can be nonoperative for non-displaced fractures but displaced injuries require anatomic open reduction and internal fixation to minimize development of post-traumatic osteoarthritis.
  • Epidemiology
    • Incidence
      • ~ 4 per 100,000 per year
    • Demographics
      • fractures occur in a bimodal distribution
        • high energy trauma in younger patients (e.g., motor vehicle accidents)
        • low energy trauma in elderly patients (e.g., fall from standing height)
  • Etiology
    • Pathoanatomy
      • fracture pattern predominately determined by
        • force vector
        • position of femoral head at time of injury
        • bone quality (e.g., age)
    • Associated conditions
      • orthopaedic manifestations
        • lower extremity injury (36%)
        • nerve palsy (13%)
          • most commonly seen in transverse + posterior wall fracture patterns
          • most commonly affects the peroneal division of the sciatic nerve 
        • spine injury (4%)
      • systemic injuries
        • head injury (19%)
        • chest injury (18%)
        • abdominal injury (8%)
        • genitourinary injury (6%)
  • Anatomy
    • Osteology
      • acetabular inclination & anteversion
        • mean lateral inclination of 40 to 48 degrees
        • anteversion of 18 to 21 degrees
      • column theory
        • acetabulum is supported by two columns of bone
        • form an "inverted Y"
        • connected to sacrum through sciatic buttress
          • posterior column
            • comprised of
              • quadrilateral surface
              • posterior wall and dome
              • ischial tuberosity
              • greater/lesser sciatic notches
          • anterior column
            • comprised of
              • anterior ilium (gluteus medius tubercle)
              • anterior wall and dome
              • iliopectineal eminence
              • lateral superior pubic ramus
    • Vascular
      • corona mortis
        • anastomosis of external iliac (epigastric) and internal iliac (obturator) vessels
        • at risk with lateral dissection over superior pubic ramus
  • Letournel Classification
    • Judet and Letournel
      • most common referenced classification system
        • classifed as 5 elementary and 5 associated fracture patterns
      • most common fracture patterns
        • younger
          • posterior wall
          • transverse fracture "family"
            • transverse
            • T-type
            • transverse + posterior wall
        • elderly
          • anterior column (e.g., quadrilateral plate fractures)
          • anterior column, posterior hemitransverse
          • assoicated both column fractures
      • Elementary patterns
        Illustration
        AP
        Obturator ob.
        Iliac ob.
        CT
        Comments 
        Posterior wall


        • Most common
        "gull sign" on obturator oblique view
        • Check for injury to superior gluteal NV bundle
        Posterior column
        • Check for injury to superior gluteal NV bundle
        Anterior wall
        • Very rare
        Anterior column
        • More common in elderly patient with fall from standing
        Transverse

        • Axial CT shows anterior to posterior fx line
        • Only elementary fx to involve both columns
      • Associated patterns

        Illustration

        AP

        Obturator ob.
        Iliac ob. 
        CT

        Comments

        Associated Both Column


        •Characterized by dissociation of the articular surface from the innominate bone
        •"spur sign"
         on obturator oblique
        Transverse + Post. Wall
        Most common associated fx
        Associated with the highest incidence of nerve injury
        T-type
        • May need combined approach
        Anterior column or wall + Post. hemitransverse
        Most common in elderly patients
        Post. column + Post. wall
        • Only associated fracture that does not involve both columns
  • Imaging
    • Radiographs
      • Recommended views
        • AP
          • obturator oblique
            • shows profile of obturator foramen
            • shows anterior column and posterior wall
          • iliac oblique
            • shows profile of involved iliac wing
            • shows posterior column and anterior wall
      • Optional views
        • inlet/outlet if concerned for pelvic ring involvement
        • examination under anesthesia (EUA)
          • used to assess posterior wall stability
          • hip positioned in flexion, adduction and axial load
          • obtain obturator oblique view
          • opening of the medial clear space suggests instability of the posterior wall fracture
      • Findings
        • radiographic landmarks of the acetabulum
          • iliopectineal line (anterior column)
          • ilioischial line (posterior column)
          • anterior wall
          • posterior wall
          • teardrop
          • weight bearing roof
            • superior acetabular rim may show os acetabuli marginalis superior which can be confused for fracture in adolescents
          • Shenton's line
        • roof arc angle
          • angle between vertical line through femoral head and line through fracture
          • helps to define fracture pattern stability
          • considered stable if the fracture line exits outside the weight bearing dome of the acetabulum
          • defined as > 45° on AP, obturator and iliac oblique views
          • not applicable for associated both column or posterior wall pattern because no intact portion of the acetabulum to measure
        • gull sign
          • represents impaction of superomedial roof
          • seen on iliac oblique view
          • pathognomic for posterior wall fractures
        • spur sign
          • represents most caudal part of intact ilium due to medialization of articular components
          • seen on obturator oblique view
          • pathognomic for ABC fractures
    • CT scan
      • indications
        • now considered a gold standard in management
      • findings
        • fracture pattern orientation
        • define fragment size and orientation
        • identify marginal impaction
        • identify loose bodies (e.g., post-reduction)
        • look for articular gap or step-off
      • roof-arc measurements
        • view
          • 2 mm fine cuts on axial view
        • findings
          • assess stability of the weight bearing dome based on the exiting fracture line
          • defined as an intact subchonral ring in the superior 10 mm of the acetabulum
          • > 2 mm incongruity in the articular segment is considered unstable
    • Duplex doppler ultrasound
      • indications
        • delayed presentation to treating hospital
        • rule out DVT
  • Treatment
    • Nonoperative
      • protected weight bearing for 6-8 weeks
        • indications
          • patient factors
            • high operative risk (e.g., elderly patients, presence of DVT)
            • morbid obesity
            • open contaminated wound
            • late presenting > 3 weeks
          • fracture characteristics
            • minimally displaced fracture (< 2 mm)
            • < 20% posterior wall fractures
              • treatment based on size of posterior wall is controversial
              • recommend an exam under anesthesia (EUA) using fluoroscopy best method to test stability
            • femoral head congruency with weight bearing roof (out of traction)
              • both column fracture pattern with secondary congruence (out of traction)
            • displaced fracture with roof arcs > 45° in AP and Judet views or >10 mm on axial CT cuts
        • technique
          • skeletal traction NOT required if stable fracture pattern, outside the weight-bearing dome
          • activity as tolerated with crutches/walker
          • weight-bearing
            • lowest joint reactive forces seen with toe-touch weight bearing and passive hip abduction
              • greatest joint contact force seen when rising from a chair on the affected extremity
          • DVT prophylaxis
          • close radiographic follow-up
    • Operative treatment
      • open reduction and internal fixation
        • indications
          • patient factors
            • < 3 weeks from date of injury
            • physiologically stable
            • adequate soft-tissue envelope
            • no local infection
              • pregnancy is not contraindication to surgical fixation
          • fracture factors
            • displacement of roof (> 2 mm)
            • unstable fracture pattern (e.g. posterior wall fracture involving > 40-50%)
            • marginal impaction
            • intra-articular loose bodies
            • irreducible fracture-dislocation
        • approaches
          • anterior
            • ilioinguinal
            • iliofemoral
            • modified stoppa
          • posterior
            • Kocher-Langenbach
          • combined
            • extended iliofemoral
        • techniques
          • factors considered for fiaxtion methodology
            • location (column and/or wall) and level (high or low) of the fracture pattern
            • amount of displacement
            • marginal impaction
            • associated injury
          • fixation modalities
            • column fixation strategies
              • reconstruction bridging plate and screws
              • percutaneous column screws
              • cable fixation
            • wall fixation strategies
              • bridge plate and screws
              • lag screw and neutralization plate
              • spring (butress) plate
        • outcomes
          • timing
            • associated hip dislocations should be reduced within 12 hours for improved outcomes
              • incarcerated fragments upon reduction can be treated with urgent ORIF or placement of skeletal traction and delayed ORIF
            • worse outcomes with fixation of fracture > 3 weeks from time of injury
              • earlier operative treatment associated with increased chance of anatomic reduction
          • peri-operative
            • clinical outcome correlates with quality of articular reduction
              • postoperative CT scan is most accurate way to determine posterior wall accuracy of reduction which has greatest correlation with clinical outcome
              • ideally articular reduction <2mm
          • post-operative
            • greatest stress on acetabular repair occurs when rising from a seated position using the affected leg, and occurs in the posterior superior portion of the acetabulum
            • functional outcomes most strongly correlate with hip muscle strength and restoration of gait postoperatively
      • total hip arthroplasty
        • indications
          • usually elderly patients with
            • significant osteopenia and/or significant comminution
            • pre-existing arthritis
          • post-traumatic arthritis in all ages
        • techniques
          • timing
            • immediate vs. delayed THA
              • immediate THA (with, or without, fracture fixation)
                • wall fractures
                  • butress plate with multi-hole cup
                • column fracture
                  • cage and cup constructs
              • delayed THA
        • outcomes
          • patients older than 60 years have approx. a 30% late conversion rate to THA after acetabular fractures
          • 10-year implant survival noted to be around 75-80%
  • Techniques
    • Percutaneous fixation with column screws
      • approach
        • anterograde (from iliac wing to ramus)
        • retrograde (from ramus to iliac wing)
        • posterior column screws
      • imaging
        • obturator outlet best view to rule out joint penetration
        • iliac inlet view best to determine anteroposterior position of screw within the pubic ramus
        • obturator inlet view best to determine position of a supraacetabular screw within tables of the ilium
    • ORIF
      • approaches
        • approach depends on fracture pattern
        • two approaches can be combined
    • Approaches
      Indications
      Risks
      Anterior Approach (Ilioinguinal)




      • Anterior wall and anterior column
      • Both column fracture
      • Posterior hemitransverse



      • Femoral nerve injury
      • LFCN injury
      • Thrombosis of femoral vessels
      • Laceration of corona mortis in 10-15%.
      Posterior Approach (Kocher-Langenbach)







      • Posterior wall and posterior column fx
      • Most transverse and T-shaped
      • Combination of above







      • Increased HO risk compared with anterior approach
      • Sciatic nerve injury (2-10%)
      • Damage to blood supply of femoral head (medial femoral circumflex)

      Extensile Approach (extended iliofemoral)

      • Only single approach that allows direct visualization of both columns
      • Associated fracture pattern 21 days after injury
      • Some transverse fxs and T types
      • Some both column fxs (if posterior comminution is present)
      • Massive heterotopic ossification
      • posterior gluteal muscle necrosis
      Modified Stoppa Approach

       • Access to quadrilateral plate to buttress comminuted medial wall fractures


      • Corona mortis must be exposed and ligated in this approach
  • Complications
    • Post-traumatic DJD
      • most common complication
      • 80% survival noted at 20 years for patients s/p ORIF
      • risk factors for DJD include
        • age >40
        • associated fracture patterns
        • concomitant femoral head injury
      • treat with hip fusion or THA
    • Heterotopic ossification
      • highest incidence with extensile approach
        • treat with
          • indomethacin x 5 weeks post-op
          • low dose external radiation (no difference shown in direct comparison)
      • lowest incidence with anterior ilioinguinal approach
    • Osteonecrosis
      • 6-7% of all acetabular fractures
      • 18% of posterior fracture patterns
    • DVT and PE
    • Infection
    • Bleeding
    • Neurovascular injury
      • risk factor
        • highest incidence with transverse + posterior wall fractures
    • Intraarticular hardware placement
    • Abductor muscle weakness
  • Prognosis
    • Poor outcomes are associated with:
      • multi-system trauma
      • increasing age
      • poor articular congruency
      • associated femoral head articular injury
      • post-traumatic arthritis

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(OBQ12.97) An 18-year-old male sustains a right hip injury after being tackled on the football field. Figure A shows his radiograph upon presentation to the emergency room three hours later. On physical exam, he is noted to have a foot drop and decreased sensation globally throughout his entire lower leg. Closed reduction under conscious sedation is immediately performed, and the hip is able to be ranged through a stable arc of motion following reduction. A post-reduction radiograph is shown in Figure B. Shortly after the reduction, the patient continues to have a foot drop, but his sensation is slightly improved. Which of the following is the most appropriate next step in management?

QID: 4457
FIGURES:
1

Exploration of his sciatic nerve

1%

(48/4238)

2

EMG

2%

(66/4238)

3

CT scan of his right hip

59%

(2485/4238)

4

Touch-down weight bearing of his right leg and observation of his sciatic nerve palsy

37%

(1566/4238)

5

Skeletal traction on the distal femur to relax tension on the sciatic nerve

1%

(42/4238)

L 3 B

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(OBQ12.212) The posterior wall of the acetabulum is best visualized on which of the following radiographic views?

QID: 4572
1

Inlet pelvis

1%

(72/6191)

2

Outlet pelvis

1%

(85/6191)

3

Anteroposterior pelvis

1%

(41/6191)

4

Obturator oblique pelvis

85%

(5252/6191)

5

Iliac oblique pelvis

12%

(715/6191)

L 2 A

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(OBQ11.22) A 34-year-old male presents with the right posterior wall acetabular fracture shown in Figure A. What is the most accurate method to test for hip stability in this patient?

QID: 3445
FIGURES:
1

The Keith method

1%

(47/3839)

2

The Moed method

1%

(37/3839)

3

The Calkins method

1%

(30/3839)

4

Dynamic fluoroscopic examination of the hip under anesthesia

96%

(3677/3839)

5

A history of associated hip dislocation

1%

(38/3839)

L 1 B

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(OBQ11.148) A 35-year-old male suffers an anterior column acetabular fracture during a motor vehicle collision, and subsequently undergoes percutaneous acetabular fixation. Intraoperatively, fluoroscopy is positioned to obtain an obturator oblique-inlet view while placing a supraacetabular screw. Which of the following screw relationships is best evaluated with this view?

QID: 3571
1

Intraarticular penetration of the screw

15%

(429/2839)

2

Position of the screw cephalad to the sciatic notch

8%

(234/2839)

3

Screw starting point at the anterior inferior iliac spine

15%

(440/2839)

4

Screw starting point at the gluteal pillar

3%

(79/2839)

5

Screw position between the inner and outer tables of the ilium

58%

(1643/2839)

L 3 B

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(OBQ11.205) A 14-year-old presents on the request of her pediatrician for evaluation of her left hip. The patient reports having a recent history of lower abdominal pain, and as part of the work-up a KUB radiograph was obtained. The abdominal work-up was negative, and her pain has since resolved, however, the pediatrician noted an abnormal radiographic finding in the left hip and requested a formal orthopedic evaluation. The patient denies any history of hip trauma or pain. A left hip radiograph is shown in Figure A, and the the abnormality in question is indicated by the white arrow. The radiographic finding is most consistent with which of the following?

QID: 3628
FIGURES:
1

Os acetabuli marginalis superior

97%

(3129/3236)

2

Fovea capitis

1%

(20/3236)

3

Myositis ossficans

1%

(33/3236)

4

Avascular necrosis.

1%

(18/3236)

5

Acetabular fracture

1%

(25/3236)

L 1 B

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(OBQ11.241) A 32-year-old male sustains a posterior wall acetabulum fracture as the result of a high-speed motor vehicle collision. Improved patient-reported outcomes after surgical treatment are associated with which of the following variables?

QID: 3664
1

Increased age

3%

(94/2725)

2

Increased hip flexion-extension arc

28%

(751/2725)

3

Immediate weight-bearing

11%

(290/2725)

4

Increased hip muscle strength

56%

(1539/2725)

5

Decreased stride length

1%

(36/2725)

L 3 C

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(OBQ11.155) A 74-year-old man falls, sustaining the injury shown in Figures A through C. In surgical planning, what is the best surgical approach to treat this injury?

QID: 3578
FIGURES:
1

Kocher-Langenbeck

14%

(405/2986)

2

Watson-Jones

3%

(85/2986)

3

Extended iliofemoral

9%

(266/2986)

4

Ilioinguinal

74%

(2204/2986)

5

Hardinge

0%

(13/2986)

L 2 A

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(OBQ11.80) A 35-year-old male undergoes closed reduction under sedation in the emergency department for a posterior hip dislocation with an associated posterior wall fracture. The post-reduction CT is seen in Figure A. What is the appropriate next step in management of this injury?

QID: 3503
FIGURES:
1

Nonoperative management based on the size of the posterior wall fragment

9%

(259/2967)

2

Operative management based on the size of the posterior wall fragment

3%

(83/2967)

3

Operative management based on the history of hip dislocation

3%

(84/2967)

4

Dynamic fluoroscopic stress exam under anesthesia in the obturator oblique view

77%

(2281/2967)

5

Dynamic fluoroscopic stress exam under anesthesia in the iliac oblique view

8%

(245/2967)

L 2 B

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(OBQ10.203) When placing a percutaneous retrograde pubic ramus screw for fixation of an acetabular fracture, which of the following radiographic views can best ensure that the screw does not exit the posterior aspect of the superior pubic ramus?

QID: 3296
1

AP pelvis

0%

(4/1659)

2

Outlet obturator oblique view

14%

(225/1659)

3

Inlet iliac oblique view

74%

(1232/1659)

4

Iliac oblique view

4%

(65/1659)

5

Obturator oblique view

8%

(128/1659)

L 3 A

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(OBQ10.268) A 78-year-old male undergoes the procedure shown in Figure A for treatment of a femoral neck fracture. As the patient passes through mid-rise during sitting to standing using the affected leg, what portion of the acetabulum experiences the highest contact pressures?

QID: 3251
FIGURES:
1

Posterior inferior

5%

(73/1600)

2

Anterior superior

17%

(275/1600)

3

Posterior superior

76%

(1210/1600)

4

Directly superior

2%

(28/1600)

5

Anterior inferior

1%

(9/1600)

L 2 B

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(OBQ10.180) A 35-year-old male sustains a posterior column/posterior wall acetabular fracture. Which of the following is the preferred approach for open treatment of this injury?

QID: 3273
1

Modified Stoppa approach

3%

(35/1178)

2

Extended iliofemoral approach

2%

(23/1178)

3

Kocher-Langenbeck approach

92%

(1087/1178)

4

Ilioinguinal approach

1%

(13/1178)

5

Combined anterior and posterior approach

1%

(15/1178)

L 1 A

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(OBQ09.223) A 37-year-old male sustains the injury shown in Figure A following a motorcycle crash. During the approach, what limb position minimizes tension placed on the sciatic nerve?

QID: 3036
FIGURES:
1

Hip at 45 degrees, knee flexed to 90 degrees

6%

(209/3344)

2

Hip at 60 degrees, knee flexed to 90 degrees

9%

(288/3344)

3

Hip at 90 degrees, knee extended

2%

(74/3344)

4

Hip at 0 degrees, knee flexed to 90 degrees

79%

(2634/3344)

5

Hip at 90 degrees, knee flexed to 90 degrees

3%

(106/3344)

L 1 A

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(OBQ09.144) A computed tomography (CT) scan has been shown to be indicated for evaluation of all of the following aspects of acetabular fractures, EXCEPT:

QID: 2957
1

Determination of surgical planning

1%

(15/1244)

2

Intra-articular loose bodies

1%

(16/1244)

3

Marginal impaction

2%

(29/1244)

4

Fracture piece size and position

0%

(6/1244)

5

Determination of pre-existing degenerative changes

94%

(1171/1244)

L 2 C

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(OBQ09.217) A 22-year-old female is involved in a motor vehicle collision and sustains the injury shown in Figures A through D. According to these images, what is the acetabular fracture classification?

QID: 3030
FIGURES:
1

Anterior column posterior hemitransverse

20%

(495/2509)

2

Both column

74%

(1854/2509)

3

Transverse

1%

(31/2509)

4

Transverse with posterior wall

3%

(86/2509)

5

Anterior column

1%

(32/2509)

L 2 A

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(OBQ09.112) A 33-year-old male sustains the injury seen in Figure A as a result of a high-speed motor vehicle collision. Based on this image, what is the most likely acetabular fracture pattern?

QID: 2925
FIGURES:
1

Both column

31%

(460/1474)

2

Anterior column

1%

(19/1474)

3

Anterior column posterior hemitransverse

5%

(70/1474)

4

Transverse

59%

(866/1474)

5

T-type

4%

(56/1474)

L 3 A

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(OBQ09.163) An acetabular fracture with all segments of the articular surface detached from the intact posterior ilium is defined as what fracture pattern?

QID: 2976
1

Transverse

6%

(140/2246)

2

Both column

75%

(1678/2246)

3

Anterior column posterior hemitransverse

11%

(246/2246)

4

Posterior column with posterior wall

5%

(120/2246)

5

Anterior column with anterior wall

2%

(50/2246)

L 2 A

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(OBQ09.198) A 25-year-old male is involved in a motor vehicle accident and presents with the injury shown in Figure A. Early fixation of this fracture pattern is associated with all of the following EXCEPT?

QID: 3011
FIGURES:
1

Decreased length of hospital stay

1%

(10/907)

2

Improved functional outcome

3%

(26/907)

3

Greater organ dysfunction

87%

(787/907)

4

Higher likelihood of being discharged to home as opposed to a rehab facility

4%

(37/907)

5

Improved fracture reduction

5%

(42/907)

L 2 C

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(OBQ09.137) The pelvic spur sign on plain radiography is indicative of the following injuries?

QID: 2950
1

Transtectal transverse acetabular fracture

7%

(159/2380)

2

Vertical shear pelvic ring injury

4%

(89/2380)

3

Displaced H-type sacral fracture

2%

(36/2380)

4

Both column acetabular fracture

86%

(2035/2380)

5

Anterior-posterior type III pelvic ring injury

2%

(53/2380)

L 1 A

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(OBQ09.99) During the ilioinguinal approach to the pelvis, the corona mortis artery must be identified and ligated if present. The corona mortis artery joins the external illiac artery with which other major artery?

QID: 2912
1

Pudendal

2%

(53/2378)

2

Deep illiac circumflex

3%

(68/2378)

3

Hypogastric

6%

(132/2378)

4

Obturator

89%

(2116/2378)

5

Testicular

0%

(2/2378)

L 1 A

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(OBQ08.119) A 42-year-old female sustains the injury seen in the computed tomography images seen in Figures A and B. According to the Letournel classification, what is the injury pattern shown?

QID: 505
FIGURES:
1

Posterior wall

1%

(14/1027)

2

Transverse

79%

(815/1027)

3

Anterior wall

2%

(23/1027)

4

Posterior column

1%

(14/1027)

5

Both column

15%

(156/1027)

L 3 A

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(OBQ08.265) Which statement is true with respect to acetabular fracture surgery as the time between injury and surgery increases?

QID: 651
1

decreased chance of anatomic fracture reduction

89%

(988/1108)

2

decreased risk of heterotopic ossification

2%

(19/1108)

3

decreased rate of neurologic injury

1%

(6/1108)

4

decreased rate of infection

1%

(10/1108)

5

decreased rate of multi-organ failure

7%

(82/1108)

L 2 B

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(OBQ07.3) In Figure A, the two red arrows point to which of the following two arteries?

QID: 664
FIGURES:
1

Superior gluteal and pudendal

2%

(17/1133)

2

Internal iliac and medial circumflex

2%

(17/1133)

3

External iliac and deep femoral

6%

(68/1133)

4

Obturator and external iliac

90%

(1021/1133)

5

Medial circumflex and inferior gluteal

0%

(5/1133)

L 1 A

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(OBQ07.98) Which of the following associated type acetabular fracture patterns is defined based on the fact that all articular segments are detached from the intact portion of the ilium, which remains attached to the sacrum through the sacroiliac joint?

QID: 759
1

Posterior wall/ posterior column

4%

(35/900)

2

Transverse

5%

(45/900)

3

T-Type

9%

(77/900)

4

Anterior column/ posterior hemitransverse

6%

(58/900)

5

Both columns

75%

(676/900)

L 2 A

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(OBQ07.230) All of the following have been shown to negatively affect clinical outcomes in treating displaced acetabular fractures, EXCEPT:

QID: 891
1

Increased age

26%

(261/1011)

2

Intraoperative complications

9%

(87/1011)

3

Ipsilateral femoral head injury

9%

(95/1011)

4

Involvement of both columns

50%

(501/1011)

5

Non-anatomic fracture reduction

6%

(65/1011)

L 3 C

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(OBQ07.114) An 74-year-old community-ambulating male presents with complaints of right hip pain for 4 months. He does not recall any specific trauma though his pain is quite severe at this point. A radiograph is shown in Figure A. What is the most appropriate definitive treatment for this patient?

QID: 775
FIGURES:
1

Skeletal traction

2%

(18/1105)

2

Conservative treatment with delayed physical therapy and shoe lifts

2%

(23/1105)

3

Open reduction and internal fixation

17%

(183/1105)

4

Right hip reconstruction

78%

(862/1105)

5

Closed reduction and percutaneous fixation

1%

(12/1105)

L 4 D

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(OBQ06.51) A 25-year-old patient presents with a posterior wall/ posterior column acetabular fracture. She is scheduled for open reduction internal fixation through a posterior approach. What position of the leg exerts the least amount of intraneural pressure on the sciatic nerve?

QID: 162
1

hip flexion, knee extension

1%

(32/2419)

2

hip extension, knee extension

3%

(63/2419)

3

hip flexion, knee flexion

5%

(129/2419)

4

hip extension, knee flexion

90%

(2177/2419)

5

the pressure does not vary based on position

0%

(8/2419)

L 1 A

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(OBQ06.166) What acetabular component is best appreciated on an obturator oblique radiograph of the pelvis as seen in Figure A?

QID: 352
FIGURES:
1

Ilioischial line

2%

(19/1189)

2

Posterior column

6%

(67/1189)

3

Posterior wall

85%

(1016/1189)

4

Anterior wall

6%

(76/1189)

5

Sacroiliac joint

0%

(3/1189)

L 1 C

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(OBQ05.8) A 32-year-old male sustains the injury shown in Figure A through D as the result of a high-speed motor vehicle collision. This particular injury is best treated with which of the following single approaches?

QID: 45
FIGURES:
1

Ilioinguinal

42%

(388/934)

2

Hardinge

1%

(11/934)

3

Extended iliofemoral

40%

(370/934)

4

Watson-Jones

2%

(17/934)

5

Kocher-Langenbeck

15%

(143/934)

L 4 A

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(OBQ05.187) When viewing pelvic injury radiographs, which of the following describes the findings diagnostic of an isolated transverse acetabular fracture?

QID: 1073
1

Fracture line crossing the acetabulum with disruption of the iliopectineal and ilioischial lines

85%

(746/879)

2

Disruption of the iliopectineal and ilioischial lines, with extension into the iliac wing and obturator ring

3%

(24/879)

3

Disruption of the iliopectineal and ilioischial lines, with extension into the obturator ring

5%

(41/879)

4

Isolated disruption of the iliopectineal line, with an intact ilioischial ine

3%

(29/879)

5

Isolated disruption of the ilioischial line, with an intact iliopectineal ine

4%

(33/879)

L 1 A

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(OBQ04.100) A 47-year-old male sustains an isolated posterior wall acetabulum fracture after a motor vehicle collision and undergoes open reduction and internal fixation. Post-operative radiographs are shown in Figure A. Which of the following has been shown to correlate most closely with good outcomes following ORIF of posterior wall fractures?

QID: 1205
FIGURES:
1

Degree of displacement seen on preoperative AP pelvis view

1%

(25/2200)

2

Degree of displacement seen on preoperative Judet views

5%

(109/2200)

3

Degree of displacement seen on preoperative pelvic CT scan

13%

(291/2200)

4

Degree of displacement seen on postoperative Judet views

13%

(291/2200)

5

Degree of displacement seen on postoperative pelvic CT scan

67%

(1479/2200)

L 2 C

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(OBQ04.93) A 45-year-old male is involved in a motor vehicle accident and sustains the injury shown in Figures A-D. Which of the following is the most appropriate approach for surgical fixation of this fracture?

QID: 1198
FIGURES:
1

Ilioinguinal

3%

(54/1888)

2

Kocher-Langenbeck

87%

(1649/1888)

3

Stoppa

3%

(52/1888)

4

Stoppa with lateral window

4%

(77/1888)

5

Extended iliofemoral

3%

(49/1888)

L 1 A

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