There is no Column; A New Classification for Acetabulum Fractures

Introduction: The surgical treatment of acetabulum fractures, relies on the understanding of fracture architecture, and their classification. The Judet and Letournel’s classification has been the corner stone in understanding and treating acetabulum fractures. However, recently there is growing evidence of discrepancies and incompleteness in the Judet and Letournel’s classification, adversely affecting its clinical use. This study describes a novel comprehensive classification system, which will direct surgical approach and fixation methods.

Methods: A retrospective study of patients with acetabulum fractures treated at a level 1 trauma center also severing as a referral center for acetabulum fractures, was performed. Fractures were classified according to both the novel and Judet and Letournel’s classification systems. The novel classification developed, integrates between the displacement vector (posterior, superior-medial or combined) and the broken anatomic structures (wall, pelvic brim, iliac wing, quadrilateral (QL) plate or ischium). Furthermore, postoperative malreduction was evaluated based on intraarticular gap measurements in either anterior-posterior (AP) or Judet’s oblique views.

Results: The study included 229 patients with acetabulum fractures treated between 2007 to 2016. Mean age was 46.7 years (SD=21.75), and 172 (75.1%) patients were surgically treated. According to the novel classification system: Posterior displacement vector group included 60 patients, Superior-medial displacement vector group included 130 patients and Combined displacement vector group that included 36 patients. Three patients were unclassified by the new classification.

Forty six patients (20.1%) could not be classified by the Judet and Letournel classification. Pelvic brim fractures patterns were described as either along or across the pelvic brim. The quadrilateral plate primary fracture line was shown to be perpendicular to the pelvic brim. The selection of surgical approach and fixation methods depends on the fracture type.

Conclusion/Summary: This study presents a novel classification system to acetabulum fractures. It offers a complete classification system, encompassing almost all fracture patterns. As selection of surgical approach and fixation methods, depends on fracture classification and understanding, the novel classification system can aid the surgeon with decision making.