Which findings on CT scans are characteristic of acetabulum fractures?

Updated: Jun 25, 2019
  • Author: David S Levey, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Answer

Brandser and Marsh described several CT scan–based observations in the classification of acetabular fractures. The following may help in the classification of these fractures [20] :

  • Transverse-type fractures divide the acetabulum into top and bottom halves, as seen from the lateral perspective of the acetabulum. Column fractures divide the acetabulum into front and back halves. Isolated wall fractures do not divide the acetabulum. In other words, is the CT scan spur sign present? Only the both-column fracture causes the spur sign.
  • Transverse-type fractures have a vertical (sagittal) CT scan orientation. Column fractures have a horizontal (coronal) orientation. Wall fractures are oriented obliquely.

CT scan features of acetabulum fractures are demonstrated below.

Acetabular fracture orientation with a computed to Acetabular fracture orientation with a computed tomography (CT) scan. A CT scan of the left midacetabulum shows that wall fractures have an oblique orientation.
Computed tomography (CT) scan of a transverse frac Computed tomography (CT) scan of a transverse fracture with a posterior wall acetabular fracture. The vertically oriented transverse fracture (arrow) of the left acetabulum is well depicted on CT scans. Note the oblique posterior wall fracture (arrowhead). Posterior wall fractures often are associated with femoral head dislocation.
Posterior column acetabular fracture. A computed t Posterior column acetabular fracture. A computed tomography (CT) scan obtained at the level of the midacetabulum shows the horizontally oriented column fracture. The femoral head is relocated, but the recent posterior dislocation is evident in the anterior impaction fracture (arrow).
Both-column acetabular fracture. A computed tomogr Both-column acetabular fracture. A computed tomography (CT) scan obtained just above the level of the acetabular dome shows that the CT scan spur sign is present (arrow).

Table 1 shows the combined set of radiographic and CT scan observations that are useful in acetabular fracture classification. (See Radiograph.)

Durkee and colleagues presented an algorithm for classification of the 5 most common types of acetabular fracture based on several observations. [9] The observations are similar to those presented in Table 1. [9]

Interpreted in conjunction with the pelvic radiographs, CT scans allow accurate fracture classification and appropriate surgical planning, as well as training in the diagnosis of acetabulum fractures. [24, 18, 25]

In a retrospective study of 300 acetabular fractures diagnosed by CT, femoral head fracture was found more likely to be present in patients with a posterior wall component of the fracture or associated hip dislocation. [18]


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