Acetabular Fracture Associated BOTH Columns

https://www.youtube.com/watch?v=5RxEh9yKqes

Associated BOTH column fracture is a fracture of both columns of the acetabulum. Both columns are separated from each other and from the axial skeleton, resulting in a floating acetabulum. This is the most complex type of acetabular fracture. The fracture type used to be called “central acetabular fracture.” This fracture pattern may be associated with central dislocation and no part of the articular surface remains attached to the axial skeleton. The acetabular fragments become free and rotate around each other. They may appear to maintain congruity to the femoral head. There is dissociation of the articular surface from the axial skeleton. Because of this secondary congruity, traction may be used in the treatment of associated both column fracture in the elderly. You will see the “spur sign” above the acetabulum on the obturator oblique view and this is diagnostic for associated BOTH column fracture. In the obturator view, you will find the anterior column (iliopectineal line) is disrupted and you will find the “spur sign.” The “spur sign” is the posterior inferior aspect t of the intact posterior ilium. Another feature of the associated BOTH column acetabular fracture is the Judet sign of the curved line. The Judet sign of the curved line occurs due to interruption by the fracture of the iliopectineal line. The curved line belongs to the greater sciatic notch and if after fixation anteriorly, the patient has a positive curved line sign, and then the posterior column is probably not reduced. The roof of the acetabulum is involved either totally or partially. When you see an x-ray and the roof of the acetabulum is in pieces, then this injury is probably an associated BOTH column fracture. You will see a coronal plane fracture through the iliac wing. In general see coronal for column fracture. If you have BOTH column fracture and there is an additional fracture going to the ilium then this is an associated BOTH column fracture. In CT scan, the fracture will be coronal. T-shaped fracture of the acetabulum is different from an associated BOTH column fracture of the acetabulum. In associated BOTH column fracture of the acetabulum, the fracture goes through the ilium. The acetabulum is floating and is disconnected from the axial skeleton. If you see extension of the transverse fracture of the acetabulum through the medial wall of the acetabulum and the fracture is going through the obturator ring, then this is a T-shaped fracture. The ilioinguinal approach is the main approach used to treat associated BOTH column fractures.