Dr. Ebraheim’s educational animated video describes the Transverse fracture of the acetabulum.
In a transverse acetabular fracture, you find the anterior column and the posterior column are fractured. It is the only elementary fracture that involves both columns. The iliopectineal (anterior column line) and the ilioischial (posterior column line) are both interrupted. Becasue of this, there is confusion about BOTH column fractures and associated BOTH column fractures. Transverse acetabular fractures involve both the anterior and posterior columns, but it is not an associated BOTH column fracture.
In a transveres fracture, the articular surface is still continuous with the ilium and with the axial skeleton. So, if you have a BOTH column fracture and ther is an additional fracture going to the ilium, then this is an associated BOTH column fracture.
In a CT scan, the fracture will be coronal.
The patient will have a floating acetabulum. The acetabulum will be disconnected from the axial skeleton.
In the CT scan, you will find the additional fracture of the ilium. The fracture of the associated BOTH column will be coronal.
In a transverse aetabular fracture, on CT scan the fracture will be sagittal, going from the anterior to posterior.
SO, if the transverse fracture goes up and involves the ilium, it is an associated BOTH column fracture. If the fracture goes down and involves the obturator foramen, then it is a T-shaped fracture.
A transverse fracture can be different types. The moe uperior the fracture line, then the greater the displacement of the acetabular dome.
The femoral head follows the inferior ischial pubic fragment and may dislocate centrally.
Three types of transverse fractures:
1.Type I (high transverse): transtectal fracture
-Occurs throught he roof of the acetabulum or the weight-bearing acetabular dome.
-The fracture fragment and femoral head are displaced medially.
-Sometimes, this fracture leaves a dent on the femoral head.
-Need to pull the femoral head away from the acetabular margin
2. Type II: Juxtatectal fracture
-Fractre is through the junction of the acetabular dome and the fossa acetabuli.
-Occurs just below the weight-bearing dome, at the junction of the cotyloid fossa.
3. Type III: infratectal fracture
-The fracture goes through the fossa acetabuli.
-The cotyloid fossa is split horizontally.
-The femoral head remains with the weight bearing acetabular dome and does not displace medially.
In CT scans, a transverse fracture does not appear transverse. It appears as a sagittal fracture that goes from anterior to posterior. So, just remember that transverse is really not transverse, it is a vertical fracture. Follow the CT scan proximal and distal. Distinguish the transverse fracture from a posterior wall fracture.
Transverse and posterior wall fractures are the most common associated acetabulum fracture.
If there is large posterior wall fracture, then you need to approach the fracture posteriorly.
Usually, the transverse component is reduced first before the posterior wall is reduced.
In general, when you treat transverse acetabular fractures with a posterior plate, the plate must be pre-bent, otherwise it will create a gap in the anterior column.
You must use a lag screw before application of the posterior plate. Insert the screws of the posterior plate of the safe zone of the acetabulum and away from the danger zone.
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