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Classification of Common Acetabular Fractures: Radiographic and CT Appearances

N. Jarrod Durkee1,2, Jon Jacobson1, David Jamadar1, Madhav A. Karunakar3, Yoav Morag1 and Curtis Hayes1,4

1 Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr., TC-2910G, Ann Arbor, MI 48109-0326.
2 Present address: Department of Radiology, University of Washington, Seattle, WA.
3 Department of Orthopedic Surgery, University of Michigan Medical Center, Ann Arbor, MI 48109-0326.
4 Present address: Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA.


Figure 1
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  		Fig. 1A —Normal pelvic bone anatomy. Surface-rendering 3D CT of pelvis in lateral view with femur and right hemipelvis removed shows anterior column (green), posterior column (blue), and sciatic buttress (red).

 

Figure 2
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  		Fig. 1B —Normal pelvic bone anatomy. Axial section through acetabulum shows anterior (arrowhead) and posterior (arrow) walls.

 

Figure 3
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  		Fig. 1C —Normal pelvic bone anatomy. Anteroposterior radiograph shows iliopectineal line (green), ilioischial line (blue), anterior acetabular wall (yellow), posterior acetabular wall (pink), and obturator foramen (O).

 

Figure 4
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  		Fig. 2A —Illustrations of classification of five most common acetabular fractures. Both-column fracture.

 

Figure 5
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  		Fig. 2B —Illustrations of classification of five most common acetabular fractures. T-shaped fracture.

 

Figure 6
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  		Fig. 2C —Illustrations of classification of five most common acetabular fractures. Transverse fracture.

 

Figure 7
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  		Fig. 2D —Illustrations of classification of five most common acetabular fractures. Transverse with posterior wall fracture.

 

Figure 8
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  		Fig. 2E —Illustrations of classification of five most common acetabular fractures. Isolated posterior wall fracture.

 

Figure 9
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  		Fig. 3 —Classification algorithm for five common acetabular fractures [2].

 

Figure 10
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  		Fig. 4A —45-year-old man with both-column acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and sagittal reconstruction CT scan (E) show acetabular fracture (straight arrows, A-C), with break in obturator ring (arrowheads, A-C) and extension into iliac wing (curved arrows). Note coronal plane of fracture on CT and superior pubic ramus fractured at puboacetabular junction.

 

Figure 11
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  		Fig. 4B —45-year-old man with both-column acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and sagittal reconstruction CT scan (E) show acetabular fracture (straight arrows, A-C), with break in obturator ring (arrowheads, A-C) and extension into iliac wing (curved arrows). Note coronal plane of fracture on CT and superior pubic ramus fractured at puboacetabular junction.

 

Figure 12
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  		Fig. 4C —45-year-old man with both-column acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and sagittal reconstruction CT scan (E) show acetabular fracture (straight arrows, A-C), with break in obturator ring (arrowheads, A-C) and extension into iliac wing (curved arrows). Note coronal plane of fracture on CT and superior pubic ramus fractured at puboacetabular junction.

 

Figure 13
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  		Fig. 4D —45-year-old man with both-column acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and sagittal reconstruction CT scan (E) show acetabular fracture (straight arrows, A-C), with break in obturator ring (arrowheads, A-C) and extension into iliac wing (curved arrows). Note coronal plane of fracture on CT and superior pubic ramus fractured at puboacetabular junction.

 

Figure 14
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  		Fig. 4E —45-year-old man with both-column acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and sagittal reconstruction CT scan (E) show acetabular fracture (straight arrows, A-C), with break in obturator ring (arrowheads, A-C) and extension into iliac wing (curved arrows). Note coronal plane of fracture on CT and superior pubic ramus fractured at puboacetabular junction.

 

Figure 15
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  		Fig. 5A —35-year-old man with both-column acetabular fracture and spur sign. Oblique pelvic radiograph (A) and axial CT image (B) show spur sign (arrow), which represents displacement of fracture involving sciatic buttress (arrowheads). Note that sciatic buttress (arrowheads, B) no longer connects to weight-bearing portion of acetabulum.

 

Figure 16
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  		Fig. 5B —35-year-old man with both-column acetabular fracture and spur sign. Oblique pelvic radiograph (A) and axial CT image (B) show spur sign (arrow), which represents displacement of fracture involving sciatic buttress (arrowheads). Note that sciatic buttress (arrowheads, B) no longer connects to weight-bearing portion of acetabulum.

 

Figure 17
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  		Fig. 6A —40-year-old man with T-shaped acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show obturator ring fractures (arrowheads) and transverse component (arrows) through acetabulum. Note characteristic oblique-sagittal orientation of transverse acetabular fracture component on CT scans that is transverse relative to acetabulum on radiographs.

 

Figure 18
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  		Fig. 6B —40-year-old man with T-shaped acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show obturator ring fractures (arrowheads) and transverse component (arrows) through acetabulum. Note characteristic oblique-sagittal orientation of transverse acetabular fracture component on CT scans that is transverse relative to acetabulum on radiographs.

 

Figure 19
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  		Fig. 6C —40-year-old man with T-shaped acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show obturator ring fractures (arrowheads) and transverse component (arrows) through acetabulum. Note characteristic oblique-sagittal orientation of transverse acetabular fracture component on CT scans that is transverse relative to acetabulum on radiographs.

 

Figure 20
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  		Fig. 6D —40-year-old man with T-shaped acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show obturator ring fractures (arrowheads) and transverse component (arrows) through acetabulum. Note characteristic oblique-sagittal orientation of transverse acetabular fracture component on CT scans that is transverse relative to acetabulum on radiographs.

 

Figure 21
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  		Fig. 6E —40-year-old man with T-shaped acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show obturator ring fractures (arrowheads) and transverse component (arrows) through acetabulum. Note characteristic oblique-sagittal orientation of transverse acetabular fracture component on CT scans that is transverse relative to acetabulum on radiographs.

 

Figure 22
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  		Fig. 7A —23-year-old woman with transverse acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show fracture (arrows) orientation transverse to acetabulum, disrupting iliopectineal and ilioischial lines (arrowheads). Note characteristic sagittal-oblique fracture plane on CT scan (D).

 

Figure 23
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  		Fig. 7B —23-year-old woman with transverse acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show fracture (arrows) orientation transverse to acetabulum, disrupting iliopectineal and ilioischial lines (arrowheads). Note characteristic sagittal-oblique fracture plane on CT scan (D).

 

Figure 24
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  		Fig. 7C —23-year-old woman with transverse acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show fracture (arrows) orientation transverse to acetabulum, disrupting iliopectineal and ilioischial lines (arrowheads). Note characteristic sagittal-oblique fracture plane on CT scan (D).

 

Figure 25
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  		Fig. 7D —23-year-old woman with transverse acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show fracture (arrows) orientation transverse to acetabulum, disrupting iliopectineal and ilioischial lines (arrowheads). Note characteristic sagittal-oblique fracture plane on CT scan (D).

 

Figure 26
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  		Fig. 7E —23-year-old woman with transverse acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show fracture (arrows) orientation transverse to acetabulum, disrupting iliopectineal and ilioischial lines (arrowheads). Note characteristic sagittal-oblique fracture plane on CT scan (D).

 

Figure 27
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  		Fig. 8A —20-year-old man showing transverse with posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show transverse fracture (straight arrows) disrupting iliopectineal and ilioischial lines (arrowheads) with displaced and comminuted posterior wall fracture fragment (curved arrows).

 

Figure 28
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  		Fig. 8B —20-year-old man showing transverse with posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show transverse fracture (straight arrows) disrupting iliopectineal and ilioischial lines (arrowheads) with displaced and comminuted posterior wall fracture fragment (curved arrows).

 

Figure 29
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  		Fig. 8C —20-year-old man showing transverse with posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show transverse fracture (straight arrows) disrupting iliopectineal and ilioischial lines (arrowheads) with displaced and comminuted posterior wall fracture fragment (curved arrows).

 

Figure 30
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  		Fig. 8D —20-year-old man showing transverse with posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show transverse fracture (straight arrows) disrupting iliopectineal and ilioischial lines (arrowheads) with displaced and comminuted posterior wall fracture fragment (curved arrows).

 

Figure 31
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  		Fig. 8E —20-year-old man showing transverse with posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT scan (D), and surface-rendering 3D CT scan viewed laterally (E), with right hemipelvis and femur removed, show transverse fracture (straight arrows) disrupting iliopectineal and ilioischial lines (arrowheads) with displaced and comminuted posterior wall fracture fragment (curved arrows).

 

Figure 32
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  		Fig. 9A —18-year-old man with isolated posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT images (D, E), and parasagittal reconstruction CT image (F) show displaced fracture fragments (curved arrows) from isolated posterior wall fracture (straight arrow, D).

 

Figure 33
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  		Fig. 9B —18-year-old man with isolated posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT images (D, E), and parasagittal reconstruction CT image (F) show displaced fracture fragments (curved arrows) from isolated posterior wall fracture (straight arrow, D).

 

Figure 34
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  		Fig. 9C —18-year-old man with isolated posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT images (D, E), and parasagittal reconstruction CT image (F) show displaced fracture fragments (curved arrows) from isolated posterior wall fracture (straight arrow, D).

 

Figure 35
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  		Fig. 9D —18-year-old man with isolated posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT images (D, E), and parasagittal reconstruction CT image (F) show displaced fracture fragments (curved arrows) from isolated posterior wall fracture (straight arrow, D).

 

Figure 36
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  		Fig. 9E —18-year-old man with isolated posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT images (D, E), and parasagittal reconstruction CT image (F) show displaced fracture fragments (curved arrows) from isolated posterior wall fracture (straight arrow, D).

 

Figure 37
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  		Fig. 9F —18-year-old man with isolated posterior wall acetabular fracture. Anteroposterior pelvic radiograph (A), bilateral oblique pelvic radiographs (B, C), axial CT images (D, E), and parasagittal reconstruction CT image (F) show displaced fracture fragments (curved arrows) from isolated posterior wall fracture (straight arrow, D).

 

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