Radiology Grand Rounds XVIII

Here is a case of Acetabular fracture for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

This patient had posterior dislocation of hip reduced about 6 months back now he presents with complaint of pain in the left hip.

FAQ (questions to be answered)
(a)Is it unreduced?
NO

(b) Has it developed AVN?
NO

(c) Is there any associated injury which Xray did not pickup?
MRI is silent on it

(d) Can anything else help?
YES CT would help

(e) What does it show?
It shows post wall fracture comminuted with loose fragment in the joint cavity

(f)What are the complications of posterior dislocation hip?
Complications-- include avascular necrosis, osteoarthosis, sciatic nerve injury and heterotrophic ossification.

(g) What are the types of acetabular fractures?
Acetabular fractures are classified according to Judet classification usually.
Walls, Columns and Transverse varieties

Wall fractures
Anterior wall
Posterior wall
Posterior column with posterior wall (also a column fracture)
Transverse with posterior wall (also a transverse fracture)

Column fractures
Anterior column
Posterior column
Both-column
Posterior column with posterior wall (also a wall fracture)
Anterior column with posterior hemitransverse (also a transverse fracture)

Transverse fractures
Transverse
T-shaped
Transverse with posterior wall (also a wall fracture)
Anterior column with posterior hemitransverse (also a column fracture)

Common types (90%)
Both-column
Transverse with posterior wall
Posterior wall
T-shaped
Transverse

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Post traumatic Spinal Cord Edema-Case Report

This is case of acute spinal cord edema in case of road traffic accident. Peculiar thing about this case was there is no vertrebral inury, only cord edema. Case submitted by Dr (Col) Murthy Sr Consultant Teleradiology Providers

Further reading--

MR imaging of recent spinal trauma. J Comput Assist Tomogr 1987 May-Jun;11(3):412-7

"Proper therapeutic management of acute spinal trauma depends considerably on the assessment of the condition of the underlying spinal cord and the relative stability of the surrounding bony architecture. A series of 14 patients who were examined by magnetic resonance (MR) imaging following spinal trauma is presented. Comparison of information gained by MR with that obtained by conventional CT indicates that MR is useful in assessing spinal cord compression, traumatic disk pathology, and post-traumatic intramedullary abnormalities. Computed tomography is more accurate in detecting posterior neural arch fractures and in assessing the number of displaced fragments."