Transitional transverse acetabular fractures Differences between fractures with a large posterio-superior fragment and the inverse T-fracture - A report of 10 unusual cases

Abstract

Background: Classification of fractures is crucial in decision making and planning of acetabular surgery. Transverse fractures with secondary vertical fracture lines - which constitute either a large posterio-superior fragment (floating dome) or an inverse T with the posterior ileum attached to the axial skeleton - have not been described in detail in the literature. Methods: All acetabular fractures at Ullevål University Hospital have been recorded prospectively since 1993 and classified according to Judet/Letournel. Results: In 10/449 fractures (2%) there was a transverse fracture line through the acetabulum, with an additional vertical fracture line ascending either to the iliac crest or the SI-joint. In 6 of these fractures the vertical line started within the acetabulum, and the posterior part of the ileum with part of the articular surface was attached to the axial skeleton. In 4 fractures the vertical fracture line started posterior to the joint, constituting a very large posterio-superior fragment without any articular surface (a floating dome). Interpretation: Open reduction and internal fixation of inverse T-fractures and transverse fractures with a floating dome require different surgical approaches. The latter can be treated through a single approach alone, while the inverse T-fracture may require extensile or combined approaches for adequate reduction and fixation. Copyright© Taylor & Francis 2005.