3D CT and Acetabular Fractures

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.00
Procedures: 2.00
Head, Spine, and Musculoskeletal: 2.00

Outline

1. Introduction
2. Development of the Acetabulum
3. Anatomy of the Acetabulum
4. Patients with Acetabular Fracture
5. Systems of Acetabular Fracture Classification
6. The Judet and Letournel Classification of Acetabular Fractures
   1. Posterior Wall
   2. Posterior Column
   3. Anterior Column
   4. Anterior Wall
   5. Transverse
   6. transverse with Posterior Wall
   7. T-shaped
   8. Associated Both-Column
   9. Anterior Column or Wall with Posterior Hemitransverse
   10. Posterior Column with Posterior Wall
7. OTA/OA Classification of Acetabular Fractures
8. Harris Classification of Acetabular Fractures
9. Imaging Acetabular Fractures
10. How to Practically Classify an Acetabular Fracture
11. Reporting and Communicating Acetabular Fractures
12. Treatment Considerations
13. Operative Acetabular Repair
14. Complications Associated with Acetabular Fractures
15. Conclusion

Objectives

Upon completion of this course, students will:

1. describe the main causes of acetabular fractures
2. know the ramifications if an acetabular fracture is not accurately classified or diagnosed
3. understand the gestational developments of the hip joint and acetabulum
4. know how the pelvic, hip, and acetabular anatomy correlate and the names of the various bones
5. describe the key topographic anatomical landmarks of the pelvis
6. know the surrounding anatomy of the acetabulum such as key ligaments, fossa, and the sciatic buttress
7. be familiar with the frequency of acetabular fractures in multiple trauma settings
8. know which age group is more susceptible to acetabular fractures
9. understand which factors play a role in defining the type of acetabular fracture
10. understand the Judet and Letournel system of acetabular fracture classification
11. understand the Orthopedic Trauma Association (OTA)/AO (Association for the Study of Internal Fixation) system of acetabular fracture classification
12. name the acetabular fracture classifications in the Judet and Letrournel system versus the OTA/AO
13. understand how the Harris system of classification of acetabular fractures developed during the advent of CT
14. name four lines that are fundamental to types of fractures in the Judet and Letournel classification system and can be viewed on a AP radiograph of the pelvis
15. know which acetabular fractures of the pelvis make up the majority of all fractures in the Judet and Letorurnel classification system
16. distinguish some of the limitations of the Judet and Letournel classification system of acetabular fractures
17. know the range of thickness of CT slices when performing a scan for pelvic trauma when the clinician is looking to rule out an acetabular fracture
18. understand what mechanism, anatomical involvement and how a posterior wall fracture of the acetabulum is viewed on an axial CT scan
19. understand what anatomical regions are involved, the stability and how a posterior column fracture of the acetabulum is viewed on an axial CT scan
20. understand the anatomical regions involved if an associated hip dislocation is present and how an anterior column fracture of the acetabulum is viewed on an axial CT scan
21. describe how the Letournel classification system differentiates anterior wall fractures of the acetabulum from anterior column fractures
22. know which acetabular fracture is the least common of all fractures
23. know what type of fragments the acetabulum is divided into with a transverse fracture
24. name all three categories of transverse acetabular fractures.
25. describe what a transverse with posterior wall fracture T-shaped variant is
26. understand how both column fractures of the acetabulum are unique
27. know what the radiographic “spur sign” is and which radiographic projection visualizes it
28. know what the anterior component of anterior with posterior hemitransverse acetabular fracture is and the patient age group it is common in
29. describe what a posterior column with posterior wall acetabular fracture is and how the posterior wall fragments may be comminuted and/or impacted
30. understand that in the Harris acetabular fracture classification system, anterior and posterior lips of the acetabulum are defined as walls, and the more medial portions of the acetabulum, including the quadrilateral plate, are considered the columns
31. understand what radiographic exposure, positioning and technical factors are key to producing both stationary and mobile pelvic radiographs
32. describe the strengths and weakness of radiography versus CT in the evaluation of acetabular fractures
33. understand the value of Judet radiographic projections and how they are performed
34. know the key CT techniques for imaging of the pelvis; including panscanning, 3D surface rendering and thin slice axial CT
35. understand the estimated radiation dose of a five view pelvic conventional radiographic study versus CT
36. understand the Brandser question-based algorithm to systematically classify acetabular fractures into a specific Judet and Letournel fracture category
37. understand how acetabular column and wall fractures are oriented at the level of the acetabular roof on CT images
38. describe the fracture modifiers in the Judet and Letournel classification system of acetabular fractures
39. name treatment options for acetabular fractures and long term outcomes of each
40. name some of the factors derived from radiography and CT that pertain to whether an acetabular fracture requires surgical intervention