Acetabulum Anterior Wall, Column, Hemi-Transverse - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубликовано: 28 мар 2018
- Dr. Ebraheim’s educational animated video describes fracture of anterior wall, anterior column, and hemi-transverse fracture of the acetabulum.
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Anterior wall fracture is a rare fracture. The fracture does not go to the obturator foramen and the ischiopubic ramus is not fractured. There will be no disruption of the iliopectineal line. There disruption of the iliopectineal line could be seen at two points. The ilioischial line is intact. The anterior wall fracture is best seen in the obturator view. Anterior wall fracture of the acetabulum is usually associated with anterior subluxation or dislocation of the hip. Anterior column fracture is usually associated with disruption of the iliopectineal line and the ilioischial line will be intact. Fracture is seen in the obturator view and the fracture will involve the obturator foramen. The ischiopubic ramus is usually fractured. The fracture is more common in old patients. Check for an associated medial wall fracture in addition to the anterior column fracture. Several types based on the location where the fracture exits the iliac bone anteriorly. High anterior column fracture, the fracture exits at the iliac crest. Intermediate anterior column fracture, the fracture exits at the anterior superior iliac spine. Low anterior column fracture, the fracture exits below the anterior inferior iliac spine. Both anterior wall and anterior column fracture of the acetabulum are treated by anterior approach of the acetabulum, such as the ilioinguinal approach. The anterior injury can be an anterior column or an anterior wall fracture. The posterior injury is a hemi-transverse fracture. The posterior hemi-transverse fracture is identical to the posterior half of the transverse fracture and it starts from the anterior acetabular fracture to the posterior innominate bone. Anterior displacement occurs more than posterior displacement. The femoral head subluxes or dislocates anteriorly. A portion of the acetabulum is attached to the iliac wing and to the axial skeleton. Therefore, this fracture is NOT an associated BOTH column fracture. In an associated BOTH column fracture, the acetabulum is disconnected from the axial skeleton and the acetabulum is a floating acetabulum. A CT scan is very helpful. It will show fractures of both columns, however the anterior column will have a coronal fracture. Coronal means column fracture and one will see that anteriorly. You will see a different fracture posteriorly. You will see a vertical or sagittal fracture in the posterior column (hemi-transverse in posterior column). Transverse fracture is NOT transverse. Transverse fracture is a vertical fracture, so you see the vertical line in the posterior column means that it is a half transverse fracture in the posterior column.
Thank you very much.. For this beautiful video
Thank You Sir For these Great Videos.
obt. oblique view best for anterior column and post wall fractures
iliac oblique view for post column and ant wall fractures
Thanks for the video doctor Nabil
Anterior wall fractures best seen Using Iliac views not Obturator views.
I believe the anterior wall fracture is better seen on the obturator view especially if the fracture is displaced
The Iliopectineal line is disrupted in 2 points .
Thank you for the clarification. The collection of videos addressing Acetabular fractures is marvelous. In addition to the great illustrations you used putting side by side a real CT will make it perfect.
Ahmed Bashendi I tried to assemble as much as helpful information and concepts.
It is not perfect but very good
I tried to share my own experience and outline what is needed . This is important for young doctors and it may not be important for the experienced ones
Sir I'm a young doctor and I really appreciate your effort to spread knowledge and enlight us. You are one of my role models that I look up to. Thank you again for taking the time deconstructing difficult concepts and make them easier to understand.