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Acetabular fracture9/19/2023 Letournel stated that force transmission along the greater trochanter to the acetabulum as well as the dashboard mechanism are possible mechanisms resulting in acetabular T-type fractures. The 3D-CT reconstruction confirms the T-shaped fracture. Axial CT clearly shows the T component, which is additionally shown on the schematic view. The IOV shows the displacement of the posterior column, and the OOV shows the displacement of the anterior column and the disruption inferior pubic ramus. 16.3 The pelvic AP view shows the disruption of both the iliopectineal and ilioischial lines. A further special fracture type is the “transverse fracture with a fracture of the anterior wall,” which is attributed to the group of T-type fractures.įig. Transitions to transverse/posterior wall fractures can exist, when the T component is leaving the obturator segment near or proximal of the ischial tuberosity. The most common fracture course is centrally through the acetabular fossa and the obturator ring. The orientation of the vertical fracture component (T component) is highly variable. Transition forms to other fracture types. A femur subtraction view or a medial hemipelvis three-dimensional (3D) view can help to clearly see the T-shaped fracture course. The exact fracture course of the T component can be analyzed, which runs through the inferior acetabular fossa into the obturator foramen ending either at the inferior pubis or ischium. The presence of intraarticular fragments and marginal impactions can be analyzed. The transverse fracture component shows high variability. Axial two-dimensional (2D) analysis confirms attachment of an articular part to the intact iliac bone connected to the axial skeleton. The integrity of the iliac fossa and iliac crest are confirmed. The vertical T component of the fracture is most clearly visible.Ĭomputed tomography ( ▶ Fig. The orientation of the anterior and often the whole transverse fracture line becomes clearer, and the “height” of the fracture course in the anterior column is observed. The remaining integrity of the acetabular dome is confirmed. The extent of the fracture line at the posterior column (greater sciatic notch) becomes clear. Often, a central femoral head dislocation is present. The acetabular roof is involved, depending on the height of the fracture. In some cases, only the inferior ramus fracture indicates the T component as an indirect sign. Frequently, the distal vertical fracture component can already be seen on this view. The characteristic lines representing the columns and therefore a transverse fracture component (iliopectineal line, ilioischial line, line of the anterior and posterior wall) are disrupted. Pelvic anteroposterior (AP) view ( ▶ Fig. In all cases, there is a complete separation of the anterior and posterior columns below the level of the transverse fracture component. In exceptional cases, a second fracture line divides the obturator ring or the fossa acetabuli. The femoral head is often dislocated centrally. 16.2 Possible extensions of the vertical T component. Transtectal fractures: the main fracture line is orientated through the superior acetabulum, leaving only a small articular fragment connected to the intact iliac bone.įig. Juxtatectal fractures: the main fracture line is orientated through the anterior and posterior wall, at the transition of the acetabular fossa to the cranial/superior joint surface ( ▶ Fig. Infratectal fractures: the main fracture line is orientated through the anterior and posterior wall, across the acetabular fossa The localization of the fracture line varies in height and inclination and, per definition, an intact articular part remains in connection to the iliac bone.Ĭomparable to pure transverse fractures, infratectal, juxtatectal, and transtectal fracture lines can be distinguished: The typical transverse fracture component in T-type fractures is orientated through the anterior and posterior column, and divides the acetabulum into an upper iliac and a lower ischiopubic segment. Presently, no adequate studies dealing with this fracture type are available. Pennal pointed out that the T-type fracture had the worst prognosis in acetabular fractures involving both columns. 1 , 3 , 4 , 5 Additionally, a clear approach recommendation is missing. T-type fractures are supposed to have the worst long-term prognosis of all acetabular fracture types, 1 , 2 possibly due to their uncommon frequency and the complexity of surgery. T-type fractures are partial articular fractures and are characterized by a simple transverse fracture line dividing the acetabulum into an upper (iliac) segment and a lower (ischiopubic) segment with an additional vertical fracture line transecting the inferior parts of the anterior and posterior column.
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