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FRACTURE
CLASSIFICATION & RADIOLOGY
RADIOGRAPHIC EVALUATION
The
acetabulum
is
evaluated
radiographically with an anteroposterior pelvic view as well as with
the 45-degree oblique views of the
pelvis described by Judet and
Letournel, commonly called Judet
views.
In the iliac oblique view, the radiographic beam is roughly perpendicular
to the iliac wing. In the obturator
oblique view, the radiographic beam
is roughly perpendicular to the
obturator foramen.
Inclusion of the opposite hip in the
radiographic
field
on
the
anteroposterior and Judet views is
essential for evaluation of symmetrical
contours that may have slight
individual variations and to determine
the width of the normal articular
cartilage in each view. The medial
clear space between the femoral
head and the radiographic teardrop
in the injured and uninjured hips
should
be
compared
on
the
anteroposterior view as an indication
of femoral head subluxation.
Fractures that traverse the anterior
column disrupt the iliopectineal
line, whereas fractures that traverse
the posterior column disrupt the
ilioischial line.
Evaluation of the various fracture
patterns
from
the
standard
radiographs requires an understanding
of the three-dimensional implications
of the status of each of the
radiographic landmarks as well as a
three-dimensional grasp of pelvic bony
anatomy and the possible variations of
fracture lines within a given fracture
pattern. In the operating room, the
three standard views can be obtained
reconstructions
helpful.
We
occasionally obtain three-dimensional
reconstructions
in
complicated
fractures, but we generally rely on
axial CT scans with coronal and
sagittal
reconstructions
correlated
with
the
standard
three
plain
radiographic views.
CLASSIFICATION
The
classification
of
acetabular
fractures described by Letour- nel
and Judet (Fig. 56-17) is the
commonly used classification system.
In this system acetabular fractures are
divided into two basic groups:
1. simple fracture types and
2. the more complex associated
fracture types.
Simple fracture types are isolated
fractures of one wall or column along
with transverse fractures; this type
includes fractures of the posterior wall,
posterior column, anterior wall, or
anterior
column
and
transverse
fractures.