Because the cup shape of the acetabulum is normally tilted inferiorly and anteriorly, the transverse fracture plane assumes a similar orientation. Fractures secondary to moderate or minimal trauma are increasingly of concern in those over 60 years because of osteoporotic changes. The transverse fracture line is not actually in the anatomic transverse plane, but rather it is transverse relative to the acetabulum. High-energy trauma is the primary cause in younger individuals and association with other fractures and pelvic ring disruptions are common. The superior gluteal vessels and nerves can be at risk from displaced fragments. Posterior column and wall fractures may be associated with femoral head fractures. As the femoral head is driven through the posterior column and fractures it, it tends to open up the posterior column like a swinging door, moving posteriorly into the pelvis. The fracture is usually displaced posteriorly, medially, and in internal rotation, as the posterior column rotates about the ischial tuberosity. The result is a complete detachment of the posterior column, in this case associated with fractures of the posterior wall. Posterior column fractures originate at the greater sciatic notch, pass through the roof or weight bearing dome and exit through the obturator ring. The posterior wall fractures involve the rim of the acetabulum, a portion of the retroacetabular surface, and a variable segment of the articular cartilage. The prevalence of this fracture is low (3.4% ). The posterior column component is often nondisplaced, and the wall fracture is the more obvious component. These fractures are a combination of the two elemental fracture patterns: posterior column and posterior wall.
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