**7.5. Posterior column with posterior wall fracture**

**7. Associated Fracture Patterns**

T-shaped fracture is a combination of transverse acetabular fracture with vertical extension into obturator ring distrupting it. Sometimes there is extension of fracture into pubic ramus and ischim. The vertical fracture component differentiates this fracture from transverse fracture. But the superior extension of the fracture does not involve the iliac wing which is an important point to differentiate this fracture from both column fracture. On the radiograph, both iliopectineal and ilioischial lines will be disrupted *in* both Judet views. On the CT scan,

There are many fracture patterns which involves both column like transverse, T-shaped fracture, transverse with posterior wall but all these fractures have to be differentiated from both column fracture. It is one of the commonest acetabular fracture pattern [13].This fracture is differentiated from all other fracture patterns in that articular surface is completely detached from the remaining portion of the iliac wing which articulate to the sacrum. The anterior and posterior columns separate from each other. It is actually a fracture involving anterior and posterior columns with fracture line extension into the obturator ring and iliac wing. Obturator ring and iliac wing involvement is a must for diagnosing this fracture pattern. Sometimes, CT scan is the only investigation to identify this fracture type. The pathognomonic sign of both column fracture is the presence of spur sign in obturator oblique view, which means the remaining portion of the ilium attached to the sacrum with sciatic buttress is seen projected lateral to the medially displaced acetabulum. Central dislocation of the femoral head is usually seen in the AP view. CT scan shows fracture involving both the columns with disruption of obturator ring and inferior pubic ramus. The main fracture line extending supe-

This fracture pattern has the characteristics of both transverse and posterior wall fractures described above. It will not disrupt the obturator foramen. In the radiograph both iliopectineal and ilioischial lines will be disrupted. Additional fracture in the posterior wall will also be seen. Obturator oblique views and CT scan will help to identified the posterior wall fracture.

The fracture line usually extends from antero-inferior iliac spine and passes inferiorly through the cotyloid fossa exiting at the superior ramus disrupting the obturator foramen. A pure transverse fracture of the posterior column alone is seen with it. It is sometimes referred as reverse T-fracture. Usually the transverse component will be undisplaced. The ilipectineal line will be always disrupted. Obturator oblique view is the most ideal view to pick up this fracture in radiograph. CT scan helps to distinguish it from transverse and

the transverse component will be seen in sagittal plane of axial image.

riorly from the acetabulum into the iliac wing is seen in the coronal plane.

**7.4. Anterior column with posterior hemitransverse fracture**

**7.3. Transverse fracture with posterior wall**

T- fractures.

**7.1. T-shaped acetabular fractures**

48 Trauma Surgery

**7.2. Both column fracture**

The fracture line will extend from the sciatic notch to the obturator ring through the cotyloid fossa. The AP view shows disruption of ilioischial line. The obturator view shows posterior wall fracture and iliac oblique view shows posterior column fracture.

Comprehensive classification has been developed to standardize the nomenclature worldwide. An alpha-numeric classification system was developed by AO group for acetabular fractures based on its severity.

Type A-Fracture involving single wall or column.

Type B-Fracture involving both anterior and posterior columns (T-type and transverse fracture).

Type C-Fracture involving both anterior and posterior columns, but all articular segments including the roof are detached from *the* remaining segment of intact ilium (Both column fracture).

The evaluation and classification of acetabular fractures based on Judet and Letournel can be concluded like this:

A. Acetabular fracture with intact obturator ring. The possibilities are:


B. Acetabular fractures with obturator ring disrupted are:


C. Acetabular fracture with obturator foramen disruption with fracture line extending to the iliac wing.

1. Bicolumn Fracture (Spur Sign).

AO comprehensive classification of the fractures acetabulum.

Type A: Partial articular, one column involved.

A1 -Posterior wall fracture.

A2 -Posterior column fracture.

A3 -Anterior wall or anterior column fracture.

Type B: Partial articular fracture.

B1 -Transverse fracture.

B2 -T shaped fracture.

B3 -Anterior column + posterior hemitransverse fracture.

Type C: Complete articular fracture.

C1 -Both column fracture, high variety.

C2 -Both column fracture, low variety.

C3 -Both column fractures involving the sacroiliac joint.

In a review of 229 patients with acetabular fractures by Herman et al. found certain fracture patterns, which cannot be included in any one of the Judet and Letournel classification. They have proposed a newer classification system based combination between the displacement vector of the fractures and the specific fracture architectural structures. But further studies are required to evaluate the utility of the proposed classification [25].

**Author details**

**References**

Trauma. 2018;**6**(1):37-44

Balaji Zacharia\*, Dhiyaneswaran Subramaniyam and Muhammed Ayyub

Department of Orthopedics, Govt. Medical College, Kozhikkode, Kerala, India

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