This gentleman was in a trauma and sustained an acetabular fracture. Here is a standard AP pelvis, “Judet” view, CT with bone windows, and a CT 3-dimensional reconstruction image. On the plain films you can see contrast in the bladder, this is residual from a urogram looking for bladder injury (no injury identified):
There are several ways to image acetabular fractures:
1. Standard AP pelvis films: this is a good screening imaging modality
2. “Judet” films: xray images that can further delineate the extent, type of acetabular fracture. wikiRadiography Judet Views
3. CT pelvis with 3-dimensional reconstruction. This is the “cadillac” of imaging that orthopedic surgeons get the most pre-operative information from. Judet Views have largely been replaced by this imaging modality as it offers much more information for the surgeon. On a PACS radiology system the images can be rotated, flipped to see the extent of the injury as if you were holding the pelvis in your hand. Its pretty awesome.
Keep in mind that fractures of the acetabulum can be occult. If you obtain plain films that look normal and the patient cannot bear weight, consider CT imaging for a better look. MRI can also be of value much like an occult femoral neck fracture.
Here is a free, extensive discussion of imaging acetabular fractures (including a discussion about types of acetabular fractures) available online from Radiographics:
Author: Russell Jones, M.D.
1. Judet Views. http://www.wikiradiography.com/page/Judet+Views
2. Potok PS, Hopper KD, Umlauf MJ. Fractures of the Acetabulum: Imaging, Classification, and Understanding. Radiographics. 1995 Jan; 15(1), 7-23.