Judet and Letournel classification for acetabular fractures
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The Judet and Letournel classification is the most widely used classification system for acetabular fractures. It classifies acetabular fractures into ten major fracture patterns, which consist of five simple patterns and five complex patterns 1,2.
Classification
The morphology of fracture patterns is described from the point of view of looking at the patient from the lateral side. Structures that are key to the classification are the walls (rims) of the acetabulum, the quadrilateral plate, and other structures of the the anterior and posterior columns of the innominate bones.
Elementary (simple) patterns
The elementary patterns break the acetabulum into two major fragments. There are five types:
- anterior wall
- segmental fracture of the middle third of the anterior column, detaching a trapezoidal fragment that contains the anterior rim/wall of the acetabulum
- superiorly, fracture line begins below the anterior inferior iliac spine 9
-
medially, fracture line involves the quadrilateral plate, so this pattern
does not includeexcludes isolated fracture of the anterior acetabular rim without involvement of the anterior column 5 - inferiorly, fracture line exits at the superior pubic ramus, distinguishing this pattern from anterior column fracture 8,9
- rare
- anterior column
- inferiorly, fracture line exits at the ischiopubic ramus
- uncommon
- transverse
- posterior column
- posterior wall
Associated (complex) patterns
The five complex patterns break the acetabulum into three major fragments:
- both column fracture
- anterior column + posterior hemitransverse fracture
- T-shaped fracture
- transverse + posterior wall fractures
- posterior column + posterior wall fractures
Epidemiology
The most frequent types, accounting for more than 80% of fractures, are posterior wall, both column, and transverse + posterior wall, followed by T-shaped and transverse 3,5,7. Thus, about one-half of acetabular fractures contain a posterior wall component 5.
Radiographic features
The classification was originally based on three radiographic views (anteroposterior view and two Judet views: obturator oblique view and iliac oblique view). However, CT with multiplanar reformations (especially the sagittal plane to replicate the lateral view of the classification) or 3D volume rendering may improve accuracy 5,6.
-</h4><p>The morphology of fracture patterns is described from the point of view of looking at the patient from the lateral side. Structures that are key to the classification are the walls (rims) of the <a title="Acetabulum" href="/articles/acetabulum">acetabulum</a>, the quadrilateral plate, and other structures of the the anterior and posterior columns of the <a title="Innominate bones" href="/articles/innominate-bones">innominate bones</a>.</p><h5>Elementary (simple) patterns</h5><p>The elementary patterns break the acetabulum into two major fragments. There are five types:</p><ol>- +</h4><p>The morphology of fracture patterns is described from the point of view of looking at the patient from the lateral side. Structures that are key to the classification are the walls (rims) of the <a href="/articles/acetabulum">acetabulum</a>, the quadrilateral plate, and other structures of the anterior and posterior columns of the <a href="/articles/innominate-bones">innominate bones</a>.</p><h5>Elementary (simple) patterns</h5><p>The elementary patterns break the acetabulum into two major fragments. There are five types:</p><ol>
-<li>segmental fracture of the middle third of the anterior column</li>-<li>superiorly, begins below the anterior inferior iliac spine <sup>9</sup>- +<li>segmental fracture of the middle third of the anterior column, detaching a trapezoidal fragment that contains the anterior rim/wall of the acetabulum</li>
- +<li>superiorly, fracture line begins below the anterior inferior iliac spine <sup>9</sup>
-<li>involves the quadrilateral plate, so this pattern does not include isolated fracture of the anterior rim without involvement of the anterior column <sup>5</sup>- +<li>medially, fracture line involves the quadrilateral plate, so this pattern excludes isolated fracture of the anterior acetabular rim without involvement of the anterior column <sup>5</sup>
- +</li>
- +<li>inferiorly, fracture line exits at the superior pubic ramus, distinguishing this pattern from anterior column fracture <sup>8,9</sup>
-<li>inferiorly, exits at the superior pubic ramus</li>-<li>anterior <a href="/articles/acetabulum">column</a>- +<li>anterior <a href="/articles/acetabulum">column</a><ul>
- +<li>inferiorly, fracture line exits at the ischiopubic ramus</li>
- +<li>uncommon</li>
- +</ul>
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