Secondary Logo

Journal Logo

The Relevance of the Judet and Letournel Acetabular Fracture Classification System in the Modern Era

A Review

Butler, Bennet A., MD; Lawton, Cort D., MD; Hashmi, Sohaib Z., MD; Stover, Michael D., MD

Journal of Orthopaedic Trauma: February 2019 - Volume 33 - Issue - p S3–S7
doi: 10.1097/BOT.0000000000001401
Supplement Article

Summary: The Judet and Letournel acetabular fracture classification system, based on the idea of bicolumnar support of the acetabulum, was first described in a landmark article published in the 1960s. It has stood the test of time and continues to be the preferred method for describing acetabular fractures for the majority of orthopaedic trauma surgeons. Still, there have been attempts to modify or replace Letournel system since its introduction for a variety of reasons, chief among them a perceived inability of the classification system to account for a number of transitional fracture patterns and injury modifiers that may affect surgical decision making and patient outcomes. In this review, we present the literature related to the Judet and Letournel acetabular fracture classification system, over 50 years after its first formal description. We summarize its strengths, weaknesses, and its place in our current understanding of acetabular fractures and their recommended management.

Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, IL.

Reprints: Bennet A. Butler, MD, Northwestern University, 676 North Saint Clair, Suite 1350, Chicago, IL 60611 (e-mail:

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted November 07, 2018

Back to Top | Article Outline


Dr. Robert Judet and his protégé, Dr. Emile Letournel, were prominent French surgeons who practiced and taught orthopaedic trauma surgery in the latter decades of the 20th century.1 Their seminal work on the radiology of the innominate bone along with their vast clinical experience led to one of their most widely known contributions to orthopaedics, the acetabular fracture classification system which bears their names.2 This classification system, based on the idea of bicolumnar support of the acetabulum, was first described in a landmark article published in the 1960s.3 It has stood the test of time and continues to be the preferred method for describing acetabular fractures for the majority of surgeons.3–5 The Judet and Letournel classification system divides acetabular fractures into 5 elementary and 5 associated patterns based on their radiographic appearance and prevalence, with the understanding that transitional patterns exist.3 Its relative simplicity can mask its tremendous effectiveness for predicting the appropriate surgical approach for a wide variety of fracture patterns.6

Despite the long, successful history of the Judet and Letournel classification system, there have been attempts to modify or replace it in the years since its development. The authors of these attempts have cited numerous reasons for these efforts. Commonly, the difficulty of mastering the classification system is seen as a major weakness.7–9 In addition, there are studies which have found as many as 35% of fractures do not fit in any of the classified patterns described.10 This may be especially true for low-energy fractures encountered in elderly patients, which often exhibit substantial quadrilateral surface involvement.10–13 Furthermore, the Judet and Letournel classification system does not account for a variety of injury characteristics that have been shown to affect fracture management and patient outcomes, such as marginal impaction, loose bodies, and femoral head involvement.14–16

In this review, we present the literature related to the Judet and Letournel acetabular fracture classification system, over 50 years after its first formal description. We aim to summarize its strengths, weaknesses, and its place in our current understanding of acetabular fractures and their recommended management.

Back to Top | Article Outline


Substantial attention has been paid to the diagnostic reliability of the Judet and Letournel classification system. For experienced acetabular fracture surgeons, the classification system is highly reliable using plain radiographs [specifically, a combination of anteroposterior (AP), obturator oblique, and iliac oblique views of the pelvis] alone. Beaule et al found that the intraobserver and interobserver kappa values for orthopaedic trauma surgeons trained by Dr. Letournel was 0.8 and 0.7, respectively, representing substantial to near-perfect agreement.17 In the same study, similar intraobserver and interobserver kappa (κ) values were obtained for orthopaedic trauma surgeons with significant acetabular fracture experience. These results were reproduced by others, including Hufner, who found that experienced acetabular fracture surgeons correctly classified acetabular fractures 83% of the time with the addition of computed tomography (CT) images (see Supplemental Digital Content Table 1,,18

For general orthopaedic surgeons and musculoskeletal radiologists, the reliability of the Judet and Letournel system has been shown to be somewhat diminished but remains fairly high. In the same study cited above by Beaule et al, general orthopaedic surgeons had intraobserver and interobserver κ values of 0.64 and 0.51, indicating moderate to substantial agreement.17 Clarke-Jenssen et al found an interobserver κ of 0.46 for general orthopaedic surgeons, and Ohashi et al found an interobserver κ of 0.42 among musculoskeletal radiologists.9,19 Similar values have been obtained by numerous other authors when testing orthopaedic surgeons without significant acetabular fracture management experience.20–24 Notably, Visutipol et al8 found moderate intraobserver agreement but poor interobserver agreement in this population (κ = 0.24).

The difficulty of mastering Judet and Letournel system is most apparent when surgeons in training are asked to classify acetabular fractures. Hufner et al7 found that residents successfully classified acetabular fractures correctly only 11% of the time using plain radiographs alone (in this and all other studies included here, plain radiographs consist of AP, obturator oblique, and iliac oblique views of the pelvis). Meanwhile, Petrisor et al21 reported an intraclass correlation coefficient of −0.14 for residents using the Letournel classification system, representing poor agreement. Other studies, however, have found residents to be somewhat more successful in classifying acetabular fractures; Ly et al,25 for example, found that residents without any prior preparation correctly classified 50% of fractures. A substantial factor in this wide discrepancy in observations seems to be the degree of resident experience with the classification.25,26 Only one published study has reported on medical student ability to use the Judet and Letournel classification system: with radiographs alone, the students were able to correctly identify just 28% of fractures.18

CT scans can provide assistance to certain groups of practitioners attempting to classify acetabular fractures. Multiple authors have reported improvements in diagnostic accuracy or agreement using CT imaging in addition to or in place of the standard AP and Judet oblique radiographs for treating surgeons, residents, and musculoskeletal radiologists.9,19,20,27–29 Others have found no improvement with the routine addition of CT imaging, especially for experienced acetabular surgeons.8,17,30 More advanced CT image manipulation has shown promise for improving acetabular fracture diagnosis, including CT-generated Judet oblique radiographs, 3D pelvic reconstructions, segmentation software for color coding fracture fragments on CT, and even the generation of 3D printed models.18,26,31–34

Back to Top | Article Outline


Because the Judet and Letournel classification system has a prolonged learning curve, many authors have described educational tools or techniques to assist residents and less experienced attending surgeons with fracture classification. In addition to providing advanced imaging, image modification, and modeling, as noted above, multiple authors have developed algorithms for correctly using the Letournel classification system.22,23,25,35,36 These algorithms focus less experienced practitioners onto specific features of the plain radiographs and have shown promise for quickly improving their ability to classify acetabular fractures.

Prevezas et al and Patel et al, using a method developed by Brandser and Marsh, independently reported improvements in the ability of general orthopaedic surgeons to diagnose acetabular fractures after being taught an algorithmic approach.22,23,35 Ly et al were able to show similar improvements in a population of orthopaedic residents who had been given their algorithm, which was based on the previous work of Saterbak et al.25,36 Before implementation of the algorithm, residents diagnosed 50% of acetabular fractures correctly; after being provided with the algorithm for one time use, they diagnosed 59% of fractures correctly. Improvements were seen for all levels of resident education.

The educational value of algorithms for classifying acetabular fractures is supported by Hanley et al,37 who used eye-tracking technology to show that residents, as compared with more experienced practitioners, had increased eye movements and fixation points when reading acetabular plain radiographs. This finding suggests a disorganized approach to diagnosis, which can theoretically be streamlined and systematized by a successful algorithm. To match the high levels of accuracy obtained by experienced acetabular fracture surgeons, however, it is likely that learners would eventually need to move past algorithmic thinking and achieve a more complete understanding of the fracture patterns and their radiographic appearance.

Back to Top | Article Outline


Although the Letournel classification system has historically been thought of as flexible and highly inclusive, unclassifiable fracture patterns have been reported.38–48 Letournel himself acknowledged that there were a wide variety of transitional patterns, which lie in the gray area between 2 established classification categories.4,5

Large epidemiological studies have found varying rates of apparently unclassifiable fractures.13,38–40 On the lower end were series published by Boudissa et al and Ochs et al, in which ∼1% of fractures were unclassifiable.13,38 Separate series by Herman et al and Mauffrey et al, however, found that 9%–20% of acetabular fractures were unclassifiable based on the Letournel system.39,40 Hutt et al10 had 3 orthopaedic surgeons classify acetabular fractures using a series of AP and Judet oblique radiographs and CT scans; 63% of these fractures determined to be unclassifiable by at least 1 surgeon. The unclassifiable fractures in the Hutt et al study were primarily anterior column fractures with quadrilateral plate involvement or incomplete fractures. This is similar to the series by Herman et al,40 where the majority of unclassifiable fractures were either anterior column fractures with quadrilateral plate involvement or dual column patterns (anterior column plus posterior hemitransverse, T-type, or both column fractures) with posterior wall involvement. It is possible that these patterns will become more common as the demographics of patients presenting with acetabular fractures changes; elderly patients are more likely to present with anteriorly based fracture patterns than patients in the general population, and comminution is frequently encountered in patients with poor bone quality.11,12

Small case series or case reports have highlighted other patterns that may not be classifiable based on the Judet and Letournel system. These include isolated quadrilateral plate injuries and anterior or inferior rim fractures without columnar involvement.41–45 Some authors have reported iliac fractures with transverse components but no inferior fracture lines as unclassifiable variants of either both column or anterior column/posterior hemitransverse fractures.46–48 In addition, the Judet and Letournel system does not account for a number of important injury modifiers that may affect management decisions. These include marginal impaction, intraarticular loose bodies, femoral head injuries, or combined acetabular fracture/pelvic ring injuries.14–16,49–51 The classification system also fails to account for newer approaches that have been developed and proliferated since the time of Letournel, including the anterior intrapelvic approach, surgical hip dislocations, and the pararectus approach.52–56 Furthermore, the Judet and Letournel system does not include information regarding roof arcs, posterior wall size, or articular displacement, all of which are important from a decision-making standpoint.57–59

Back to Top | Article Outline

Other Classification Systems

The earliest published acetabular fracture classification system, to our knowledge, was proposed by Rowe, and divided fractures into undisplaced, inner wall, posterior, and superior/burst patterns.60 This was supplanted shortly after its introduction by the Judet and Letournel system. Tile presented a different classification system, which built upon and expanded Judet and Letournel's work.61 His classification system split fractures into type A partial articular (including posterior wall and single column fractures), type B complete articular (including transverse, T-type, and anterior column/posterior hemitransverse fractures), and type C both column fractures, including those with sacroiliac joint involvement. Within each group are further subdivisions allowing for associated patterns and further specifying fracture line location. A similar, but more broadly divided classification system was developed by Harris et al based on CT imaging.62–64 This classification separated injuries into wall fractures, single column fractures, 2 column fractures, and both column injuries. Neither of these classifications has been reported to have improved utility in the determination of surgical approach or patient outcomes.

More recently, Herman et al40 developed a classification system based on displacement vector and structures fractured with the goal of predicting surgical approach and improving inclusivity as compared with the Judet and Letournel system. It divides fractures into posterior displacement, superomedial displacement, and combined displacement groups. Within these groups are further subdivisions based on which structures are fractured. According to the authors' evaluation of radiographs, this new classification system encompassed over 99% of fractures, as opposed to the Judet and Letournel system, which encompassed just under 80% of fractures. Furthermore, the new classification system was able to correctly predict surgical approach for the majority of fractures, especially those which the authors felt were amenable to an intrapelvic approach.

Back to Top | Article Outline


Since its introduction in the 1960s, the Judet and Letournel acetabular fracture classification system has been widely adopted by orthopaedic surgeons, and orthopaedic traumatologists in particular.3–5 It has a long and successful track record for determining the appropriate surgical approach for fracture treatment.6 From a prognostic perspective, there are certain fracture patterns in the classification that are associated with worse outcomes.6,65

Despite its successes, some authors have been critical of Judet and Letournel system. As noted above, it can be a difficult classification system to master.8,21 Although this might suggest some degree of unwieldiness, it is more likely that the difficult learning curve is attributable to the challenging nature of acetabular fractures rather than anything inherent to the classification system. For surgeons who have extensive experience with acetabular fractures, this classification system has a high intraobserver and interobserver reliability using the 3 standard plain radiographs.17 The addition of CT imaging can further improve the reliability of fracture classification and can provide prognostically important details about the injury pattern which plain radiographs might not be able to detect (such as marginal impaction, loose bodies, and femoral head impaction injuries).9,14–16,19,20,27–29

There have been numerous studies reporting disappointingly high rates of unclassifiable fractures using the Letournel system.10,39,40 The majority of these fractures, however, are either anterior column fractures with quadrilateral plate involvement, incomplete fractures, or patterns with associated posterior wall fractures that are not specifically categorized.10,40 For these patterns, the fact that they are not classifiable in a technical sense does not invalidate Judet and Letournel classification system. These fractures are analogous to fracture patterns defined by the classification system, and many can be managed similarly. The same is true for the rare unclassifiable fracture patterns noted in the case reports above, which can typically be dealt with similarly to the defined pattern they most resemble.41–48 Many of these so-called unclassifiable fractures were described or predicted by Letournel himself, who acknowledged that a wide range of transitional patterns existed.4,5

Proposed alternatives to Judet and Letournel fracture classification system have their own shortcomings. Broader classification systems will have trouble meaningfully differentiating fractures and determining management or predicting outcomes. For those surgeons who do not need a detailed understanding of fracture treatment, however, such classifications (eg, the first level of the Tile classification) may serve as a reliable way to grossly differentiate patterns. However, more complex classification systems will suffer from limited clinical applicability and low interobserver and intraobserver diagnostic reliability. This has been observed with the AO classifications for articular fractures, where the intraobserver and interobserver reliability is degraded by progressive increases in classification complexity.66,67

The recent classification system proposed by Herman is an interesting departure from traditional systems.40 It is our opinion, though, that the inclusion of displacement vector as a primary fracture pattern differentiator may be misleading. For example, although the superomedial group would frequently call for anterior intrapelvic approach as proposed by the authors, there are a number of patterns included in this group, such as transtectal transverse fractures, for which some surgeons would choose a different approach. In addition, the presence of a posterior wall fracture in combination with a bicolumnar fracture pattern does not necessarily indicate a combined displacement vector, as the new classification system suggests. In our experience, the posterior wall component of these injuries is a bending wedge fracture, which occurs during superomedial displacement of the femoral head. Often it remains minimally displaced with the acetabular labrum intact and can be managed through an anterior approach with directed intrapelvic to extrapelvic interfragmentary screw fixation.68,69

Currently, Judet and Letournel classification system remains the gold standard for acetabular fractures. Rather than modifying Judet and Letournel system to make it easier to master, efforts should be focused on improving our teaching methods. Already, methods for teaching the classification system using advanced imaging, 3D models, and algorithms have shown promise for quickly developing competence among trainees, and recent graduates.18,22,23,25,26,31–36 New educational techniques, possibly including an integrated curriculum using a number of the teaching tools noted above, would be of substantial value in residency or fellowship training.

Nevertheless, low-energy fractures in the elderly, which tend to be qualitatively different than those fractures encountered in younger patients, may require reevaluation and additional subclassifications within the existing system.10–13 It is our expectation that, modified or not, the Judet and Letournel system will continue to guide future acetabular fracture surgeons with regard to the determination of the appropriate surgical approach for fracture treatment and overall patient management decision making.

Back to Top | Article Outline


1. Somford MP, de Visser E, Ijpma FF. The origins and current applications of classic eponymous terms for pelvic and acetabular fractures: a historic review. J Trauma Acute Care Surg. 2017;82:802–809.
2. Johnson EE, Matta JM, Mayo KA, et al. A tribute to Emile Letournel, MD (1927–1994). Clin Orthop Relat Res. 1995:281–282.
3. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964;46:1615–1646.
4. Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. New York, NY: Springer; 1993.
5. Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980;151:81–106.
6. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78:1632–1645.
7. Hufner T, Pohlemann T, Gansslen A, et al. The value of CT in classification and decision making in acetabular fractures. A systematic analysis. Unfallchirurg. 1999;102:124–131.
8. Visutipol B, Chobtangsin P, Ketmalasiri B, et al. Evaluation of Letournel and Judet classification of acetabular fracture with plain radiographs and three-dimensional computerized tomographic scan. J Orthop Surg (Hong Kong). 8:33–37.
9. Ohashi K, El-Khoury GY, Abu-Zahra KW, et al. Interoberver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary? Radiology. 2006;241:386–391.
10. Hutt JR, Ortega-Briones A, Daurka JS, et al. The ongoing relevance of acetabular fracture classification. Bone Joint J. 2015;97-B:1139–1143.
11. Ferguson TA, Patel R, Bhandari M, et al. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010;92:250–257.
12. Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg. 1999;7:128–141.
13. Ochs BG, Marintschev I, Hoyer H, et al. Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German pelvic multicentre study group (DAO/DGU). Injury. 2010;41:839–851.
14. Giannoudis PV, Kanakaris NK, Delli Sante E, et al. Acetabular fractures with marginal impaction: mid-term results. Bone Joint J. 2013;95-B:230–238.
15. Alton TB, Gee AO. Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res. 2014;472:35–38.
16. Mauffrey C, Stacey S, York PJ, et al. Radiographic evaluation of acetabular fractures: review and update on methodology. J Am Acad Orthop Surg. 2018;26:83–93.
17. Beaulé PE, Dorey FJ, Matta JM. Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability. J Bone Joint Surg Am. 2003;85-A:1704–1709.
18. Sebaaly A, Riouallon G, Zaraa M, et al. Standardized three dimensional computerized tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop. 2018;42:1957–1965.
19. Clarke-Jenssen J, Ovre SA, Roise O, et al. Acetabular fracure assessment in four different pelvic trauma centers: have the Judet views become superfluous? Arch Orthop Trauma Surg. 2015;135:913–918.
20. O'Toole RV, Cox G, Shanmuganathan K, et al. Evaluation of computed tomography for determining the diagnosis of acetabular fractures. J Orthop Trauma. 2010;24:284–290.
21. Petrisor BA, Bhandari M, Orr RD, et al. Improving reliability in the classification of fractures of the acetabulum. Arch Orthop Trauma Surg. 2003;123:228–233.
22. Patel V, Day A, Dinah F, et al. The value of specific radiological features in the classification of acetabular fractures. J Bone Joint Surg Br. 2007;89:72–76.
23. Prevezas N, Antypas G, Louverdis D, et al. Proposed guidelines for increasing the reliability and validity of Letournel classification system. Injury. 2009;40:1098–1103.
24. Hurson C, Tansey A, O'Donnchadha B, et al. Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. Injury. 2007;38:1158–1162.
25. Ly TV, Stover MD, Sims SH, et al. The use of an algorithm for classifying acetabular fractures: a role for resident education? Clin Orthop Relat Res. 2011;469:2371–2376.
26. Sinatra PM, Moed BR. CT-generated radiographs in obese patients with acetabular fractures: can they be used in lieu of plain radiographs? Clin Orthop Relat Res. 2014;472:3362–3369.
27. Garrett J, Halvorson J, Carroll E, et al. Value of 3D CT in classifying acetabular fractures during orthopedic residency training. Orthopedics. 2012;35:e615–20.
28. Jouffrey P, Sebaaly A, Aubert T, et al. Improved acetabular fracture diagnosis after training in a CT-based method. Orthop Traumatol Surg Res. 2017;103:325–329.
29. Schäffler A, Fensky F, Knöschke D, et al. CT-based classification aid for acetabular fractures: evaluation and clinical testing. Unfallchirurg. 2013;116:1006–1014.
30. Harley JD, Mack LA, Winquist RA. CT of acetabular fractures: comparison with conventional radiography. AJR Am J Roentgenol. 1982;138:413–417.
31. Kickuth R, Laufer U, Hartung G, et al. 3D CT versus axial helical CT versus conventional tomography in the classification of acetabular fractures: a ROC analysis. Clin Radiol. 2002;57:140–145.
32. Borrelli J Jr, Peelle M, McFarland E, et al. Computer-reconstructed radiographs are as good as plain radiographs for assessment of acetabular fractures. Am J Orthop (Belle Mead NJ). 2008;37:455–459.
33. Boudissa M, Orfeuvre B, Chabanas M, et al. Does semi-automatic bone-fragment segmentation improve reproducibility of Letournel acetabular fracture classification. Orthop Traumatol Surg Res. 2017;103:633–638.
34. Hansen E, Marmor M, Matityahu A. Impact of three-dimensional “hands-on” anatomic teaching module on acetabular fracture pattern recognition by orthopaedic residents. J Bone Joint Surg Am. 2012;94:e1771–7.
35. Brandser E, Marsh JL. Acetabular fractures: easier classification with a systematic approach. AJR Am J Roentgenol. 1998;171:1217–1228.
36. Saterbak AM, Marsh JL, Turbett T, et al. Acetabular fractures classification of Letournel and Judet—a systematic approach. Iowa Orthop J. 1995;15:184–196.
37. Hanley J, Warren D, Glass N, et al. Visual interpretation of plain radiographs in orthopaedics using eye-tracking technology. Iowa Orthop J. 2017;37:225–231.
38. Boudissa M, Francony F, Kerschbaumer G, et al. Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: retrospective study of 414 patients over 10 years. Orthop Traumatol Surg Res. 2017;103:335–339.
39. Mauffrey C, Hao J, Cuellar DO III, et al. The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable? Clin Orthop Relat Res. 2014;472:3332–3337.
40. Herman A, Tenenbaum S, Ougortsin V, et al. There is No column: a new classification for acetabular fractures. J Bone Joint Surg Am. 2018;100:e8.
41. Laflamme GY, Delisle J, Leduc S, et al. Isolated quadrilateral plate fracture: an unusual acetabular fracture. Can J Surg. 2009;52:E217–E219.
42. Pascarella R, Digennaro V, Grandi G. Osteochondral impaction of the posterior acetabular surface without cortical fracture of any wall or column: an undescribed pattern of acetabular injury. J Orthop Traumatol. 2011;12:101–105.
43. Douraiswami B, Vinayak G. Isolated quadrilateral plate fracture of the acetabulum- A unique case scenario. J Orthop Case Rep. 2012;2:32–34.
44. de Bruin V, de Ridder V, Gautier E. Isolated fractures of the teardrop of the acetabulum. Arch Orthop Trauma Surg. 2011;131:969–972.
45. Lenarz CJ, Moed BR. Atypical anterior wall fracture of the acetabulum: case series of anterior acetabular rim fracture without involvement of the pelvic brim. J Orthop Trauma. 2007;21:515–522.
46. Tavakoli Darestani R, Kazemian G, Emami Moghaddam M, et al. An unusual combination of acetabular and pelvic fracture: is this a new subtype of acetabular fracture? Trauma Mon. 2013;18:37–40.
47. Berton C, Bachour F, Migaud H, et al. A new type of acetabular fracture: “True” posterosuperior fracture, a case report. Rev Chir Orthop Reparatrice Appar Mot. 2007;93:93–97.
48. Øvre S, Madsen JE, Røise O. Transitional transverse acetabular fractures: differences between fractures with a large posterio-superior fragment and the inverse T-fracture—a report of 10 unusual cases. Acta Orthop. 2005;76:803–808.
49. Osgood GM, Manson TT, O'Toole RV, et al. Combined pelvic ring disruption and acetabular fracture: associated injury patterns in 40 patients. J Orthop Trauma. 2013;27:243–247.
50. Suzuki T, Smith WR, Hak DJ, et al. Combined injuries of the pelvis and acetabulum: nature of a devastating dyad. J Orthop Trauma. 2010;24:303–308.
51. Halvorson JJ, Lamothe J, Martin CR, et al. Combined acetabulum and pelvic ring injuries. J Am Acad Orthop Surg. 2014;22:304–314.
52. Keel MJ, Ecker TM, Cullmann JL, et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg Br. 2012;94:405–411.
53. Siebenrock KA, Gautier E, Woo AK, et al. Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum. J Orthop Trauma. 2002;16:543–552.
54. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;305:112–123.
55. Archdeacon MT. Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum. J Orthop Trauma. 2015;29(suppl 2):S6–S9.
56. Kistler BJ, Sagi HC. Reduction of the posterior column in displaced acetabular fracture through the anterior intrapelvic approach. J Orthop Trauma. 2015;29(suppl 2):S14–S19.
57. Matta JM, Anderson LM, Epstein HC, et al. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res. 1986;205:230–240.
58. Tornetta P III. Non-operative management of acetabular fractures: the use of dynamic stress views. J Bone Joint Surg Br. 1999;81:67–70.
59. Dodd A, Osterhoff G, Guy P, et al. Radiographic measurement of displacement in acetabular fractures: a systematic review of the literature. J Orthop Trauma. 2016;30:285–293.
60. Rowe CR, Lowell JD. Prognosis of fractures of the acetabulum. J Bone Joint Surg. 1961;43A:30.
61. Tile M. Classification of acetabular fractures. In: Fractures of the Pelvis and Acetabulum. 2nd ed. Baltimore, MD: Williams & Wilkins; 1995:259–304.
62. Harris JH Jr, Lee JS, Coupe KJ, et al. Acetabular fractures revisited: Part 1, redefinition of the Letournel anterior column. AJR Am J Roentgenol. 2004;182:1363–1366.
63. Harris JH Jr, Coupe KJ, Lee JS, et al. Acetabular fractures revisited: part 2, a new CT-based classification. AJR Am J Roentgenol. 2004;182:1367–1375.
64. Chmelova J, Dzupa V, Sprindrich J, et al. Can the new CT-based classification of acetabular fractures be useful for clinical practice? Acta Chir Orthop Traumatol Cech. 2007;74:210–217.
65. Giannoudis PV, Grotz MR, Papakostidis C, et al. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br. 2005;87:2–9.
66. Walton NP, Harish S, Roberts C, et al. AO or Schatzker? How reliable is classification of tibial plateau fractures? Arth Orthop Trauma Surg. 2003;123:396–398.
67. Swiontkowski MF, Sands AK, Agel J, et al. Interobserver variation in the AO/OTA fracture classification system for pilon fractures: is there a problem? J Orthop Trauma. 1997;11:467–470.
68. Min BW, Lee KJ, Jung JW, et al. Outcomes are equivalent for two-column acetabular fractures either with or without posterior-wall fractures. Arch Orthop Trauma Surg. 2018;138:1223–1234.
69. Wang H, Utku K, Zhuang Y, et al. Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement. Injury. 2017;48:1510–1517.

Judet; Letournel; acetabulum; acetabular fracture; classification; classification system

Supplemental Digital Content

Back to Top | Article Outline
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.