11 acetabulum 2016-radiograph and model interpretation …...polytrauma, pelvis and acetabulum...
TRANSCRIPT
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Acetabular Fracture Classification and Image Interpretation
OTA Resident Comprehensive Fracture Course
Polytrauma, Pelvis and Acetabulum Module
Objectives
•Introduce acetabular anatomy
•Introduce classification system•Introduce radiographic interpretation
•Emphasis on plain X‐rays
Don’t Make it Too Hard
•It’s complicated, but keep it simple
•Take your time
•Use all your imaging
•Patterns are important
•“Experts” don’t always agree on classification
Anatomy
• Judet & Letournel (1966)
• Inverted “Y” Two Column Concept
• Columns connected to SI joint by Sciatic Buttress
Anatomy of the Acetabulum
Anterior ColumnPosterior Column
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Have a System for Image Interpretation
•Evaluate imaging the same way every time
•Brandser E, Marsh JL. Acetabular fractures: easier classification with a systematic approach. AJR1998;171:1217‐28
Acetabular Radiographic Anatomy
“The 6 Radiographic Lines of Judet”•Anterior Wall •Posterior Wall •Sourcil (Roof)•Posterior Column ‐ Ilioischial Line)
•Anterior Column ‐Iliopectineal Line
•Teardrop (Medial Wall)
Radiographic Evaluation
•Plain Radiographs• AP Pelvis • Judet Views
• Iliac Oblique• Obturator Oblique
•CT Scan• Axial &reconstructions• 3D if available
AP Pelvis
Visualize All 6 Radiographic Landmarks
Brandser & Marsh AJR 1998
Judet Views ‐ Iliac Oblique
Visualize Anterior Wall & Posterior Column
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Judet Views ‐ Obturator Oblique
Visualize Posterior Wall & Anterior Column
CT Scans
Column Fx Transverse Fx
Column Fx
Transverse Fx
horizontal
vertical
Fracture Patterns
•Simple/Elementary Types
• Anterior Wall
• Posterior Wall
• Anterior Column
• Posterior Column
• Transverse
•Associated/Combined Types
• Posterior Column / Posterior Wall
• Transverse Posterior Wall
• Anterior Column / Posterior Hemitransverse
• T‐Type
• Both Column
Anterior Wall
Posterior Wall
Anterior Column
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Posterior Column
Transverse
Posterior Column / Posterior Wall
Transverse Posterior Wall
T‐Type
Anterior Column / Posterior Hemitransverse
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Both Column
Radiographic Analysis –Associated Types
•Both Column• Disruption of Both Iliopectineal & Ilioischial Lines
• Complete Detachment of Articular Surface From Ilium = Spur Sign
Spur Sign = Both Column Fx
Systematic Approach: Pattern Recognition
Brandser & Marsh AJR 1998
Are both IP and II lines intact?
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Are both the IP and II lines disrupted?
Is only the IP line disrupted?
Is only the II line disrupted?
Iliac Wing Extension?
Obturator ring extension?
Acetabulum RadiographInterpretation Cases
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1. AP pelvis
1. Iliac Oblique
1. Obturator Oblique
2. AP pelvis
2. AP pelvis
2. Iliac Oblique
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2. Obturator Oblique
3. AP pelvis
3. Iliac Oblique
3. Obturator Oblique
3. 3D
4. AP pelvis
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4. AP pelvis‐post reduction, traction
4. Iliac Oblique
4. Obturator Oblique
5. AP pelvis
5. Iliac Oblique
5. Obturator Oblique
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5. 3D
6. AP pelvis
6. Iliac Oblique
6. Obturator Oblique
7. AP pelvis
7. Iliac Oblique
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7. Obturator Oblique
8. AP pelvis
8. Iliac Oblique
8. Obturator Oblique
9. AP pelvis
9. Iliac Oblique
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9. Obturator Oblique
9. CT scan
9. CT scan
9. CT scan
10. AP pelvis
10. Iliac Oblique
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10. Obturator Oblique
11. AP pelvis
11. AP pelvis – In Traction
11. Iliac Oblique
11. Obturator Oblique
12. AP pelvis
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12. Iliac Oblique
12. Obturator Oblique
13. AP pelvis
13. Iliac Oblique
13. Obturator Oblique
14. AP pelvis
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14. Iliac Oblique
14. Obturator Oblique
15. AP pelvis
15. Iliac Oblique
15. Obturator Oblique