Virginia Via Research Day Book 2026

Medical Student Research Case Reports

09 CHRONIC POSTERIOR ACETABULAR FRACTURE

Morgan Hadank, OMS-II; Kyle Hopkins, DO; Alex Black, MAEd, LAT, ATC; Brett Griesemer, MAEd, LAT, ATC, CSCS; Benjamin Coobs, MD; Matthew Chung, DO, CAQSM, R-MSK, FAOASM; Mark Rogers, DO, CAQSM, FAAFP, FAOASM Corresponding author: mhadank@vcom.edu

Merryman Athletic Center, Virgina Tech Athletics, Blacksburg, Virginia

Given the appearance, it was believed to be a chronic finding, and the associated soft tissue, chondral, and muscular abnormalities were the acute pathology. Comments: An investigation of similar cases was conducted utilizing National Institute of Health, PubMed. Most commonly, posterior acetabular fractures are from an acute high velocity injury, including those similar in our athlete with an axial load impacting the femoral head into the posterior acetabulum. The most common imaging modality for these injuries is CT. Sources have also used a dynamic fluoroscopic exam under anesthesia to assess hip stability. Both surgical and nonsurgical approaches have been reported. The surgical approach is indicated with articular instability. Nonoperative management includes non-weight-bearing status, NSAIDs, and physical therapy. Return to play for non-surgical approaches are typically 8-12 weeks with monitoring. Our patient was made non-weight-bearing with crutches, prescribed diclofenac for the associated myofascial injuries, and held from football activities. Rehab began at approximately 4 weeks. Diagnosis: Right chronic nonunion posterior acetabular fracture with full-thickness femoral head articular chondral defect with subchondral marrow

edema. Additional acute right anterosuperior acetabular labral tear and strain to the hip capsule, gluteus minimus, medius, and deep external rotators. Treatment: The athlete was restricted from activities and referred to an orthopedic hip specialist. Non operative management with initial non-weight-bearing status was trialed. Follow-up MRI at one month showed a stable alignment of the right posterior acetabular fracture, a full-thickness right femoral head articular chondral defect with subchondral marrow edema, a stable labral tear, hip capsular strain, gluteus minimus and obturator internus muscle strains. He has been continuing with rehab and is tentatively targeting return to football in the spring. demonstrates an example of a subsequent injury to the myofascial units surrounding the posterior acetabulum on secondary injury. While unclear when or how the initial acetabular fracture occurred, this case shows the role that different imaging modalities have in elucidating chronicity of injuries and associated sequelae. Conclusion: Posterior acetabular fractures are somewhat rare traumatic injuries. This case

Context: Athlete presented with right hip pain after football-related injury with concern for hip dislocation and posterior acetabular fracture. Ultimately, it was determined that, despite denying previous injury, he had potentially previously fractured his acetabulum, and the current pathology further complicated this. Report of Case: During practice, our athlete sustained an injury when he and a defender fell directly onto his flexed right knee. He was able to ambulate to the nearby training room, where initial exam showed tenderness with FADIR felt in the posterior hip as well as with posterior translation at the femoroacetabular joint and tenderness along the greater trochanter. External rotation, FABER, and Thomas testing were normal. Initial imaging with an AP radiograph of the pelvis was unremarkable. Due to high concern for fracture, we obtained a CT scan, which revealed a chronic-appearing nonunion fracture of the posterior acetabulum. MRI then showed a minimally displaced posterior right acetabular wall fracture, full-thickness femoral articular chondral defect with underlying marrow edema, and right anterosuperior and inferior acetabular labral injury. Soft tissue involvement included acute near-complete tears of the deep external rotators of the hip and gluteus medius muscle strain.

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46 Edward Via College of Osteopathic Medicine (VCOM)