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SYMPOSIUM Table of Contents   
Year : 2002  |  Volume : 36  |  Issue : 1  |  Page : 5-7
Classification of acetabular fractures


TN Medical college and BYL Nair Charitable Hospital Mumbai, India

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How to cite this article:
Dhar S. Classification of acetabular fractures. Indian J Orthop 2002;36:5-7

How to cite this URL:
Dhar S. Classification of acetabular fractures. Indian J Orthop [serial online] 2002 [cited 2020 Jan 18];36:5-7. Available from: http://www.ijoonline.com/text.asp?2002/36/1/5/35912
Acetabular fractures are difficult to classify due to the many variables that exist. These include the anatomic types, the direction of displacement, the presence or absence of a dislocation, the number of fragments, marginal impaction of fragments, damage to the articular surface of the femoral head. The Judet and Letournel [1] classification is still the most widely used. It is purely an anatomical classification and it neither encompasses the various patterns, nor addresses the various factors affecting the natural history e.g. the degree and direction of displacement, comminution, etc.

In the past decade some agreement has been reached on the development of a universal classification, which permits comparison between series and serves as a guide to treatment. This comprehensive classification, a modification of the AO classification [2] , is now widely used and has been approved by SICOT, AO group and the Orthopaedic Trauma Association (OTA).

In Judet and Letournel classification [1] the fractures are divided into two major types, Elementary and Associated or Complex types with each having its subgroups [Figure 1]

Type A: Posterior wall fracture.

Type B: Posterior column fracture

Type C: Anterior wall fracture

Type D: Anterior column fracture

Type E: Transverse fracture

Type F: Posterior column and posterior wall fracture.

Type G: Transverse and posterior wall fracture

Type H: T shaped fracture.

Type I: Anterior and Posterior hemi-transverse fracture

Type J: Complete both column fracture

In the Universal classification the fractures are classified into three main types A, B, C in increasing order of severity.

Type A are the partial articular fractures,

Type B: transverse or T fractures and

Type C: both column fractures.

Comprehensive classification [2] [Figure 2]

Type A fracture:

Only one portion of the acetabular articular surface is involved, the remainder of that surface is intact. Thus only one column and/or a corresponding wall is involved. Dislocation (anterior /post) is commonly associated.

A1 (Posterior wall fractures)

Posterior wall fracture may be associated with any other fracture type like posterior column (A2), transverse (B1) or both column(C) fractures.

A1-1 is a pure posterior dislocation with one single fragment. Fragment may be posterior, posterosuperior, and posteroinferior.

A1-2 is pure posterior dislocation with multiple fragments.

A1-3 is pure fracture dislocation with marginal impaction.

A2 (Posterior column fractures)

Isolated fractures of the posterior column are rare. Several subgroups of A2 fractures are recognized.

A2-1. The column fracture remains within the ischium

A2-2. This fracture extends through the obturator ring usually preserving the teardrop.

A2-3. Posterior column fracture associated with the posterior wall fracture.

A3 (Anterior column and/or Anterior wall fractures)

Pure anterior fracture types are rare injuries. Although fractures of the pubic rami often extendin g to the hip joint are common, these are usually considered as pelvic ring injuries.

A3-1 is a pure anterior wall fracture and is almost always associated with the anterior dislocation (abduction external rotation injury).

A3-2 (High variety) the fracture line reaches the iliac crest.

A3-3 (Low variety) fracture line exits below the anterior inferior iliac spine. Anterior column fractures may produce one or more fragments.

TypeB: Transverse or T type (Partial Articular fractures)

B1 (Transverse fractures) here
the innominate bone is divided into two parts, the superior ilial and inferior ischeo pubic

B1-1 (Infratectal) the fracture line passing inferior to the weight bearing part of the joint surface

B1-2 (Transtectal) fracture divides the articular surface through major weight bearing area. Associated acetabular wall fractures are designated as suffix "a"

a1: pure transverse fracture without any posterior wall involvement.

a2: + posterior wall single fragment fracture

a3: + multi fragment posterior wall fracture.

a4: + posterior wall, multifragmentary with marginal impaction

B2 (T Fracture, Partial articular)

In addition to the transverse component there is vertical split of the acetabulum as well. Central dislocation is common. Recognition of the t-component is of great surgical significance. Anatomic reduction of any one column in a transverse fracture can reduce both the columns perfectly, however if there is a T-component, reduction of one column does not reduce the other.

T-fractures can also be further subdivided : B2-1 Infratectal; B2-2 : juxtatectal; B2-3 Transtectal; depending upon the position of the vertical component.

B3 (anterior column with posterior hemitransverse lesion)

There is an anterior column fracture associated with a posterior hemi transverse fracture. Subgroups can be

B3-1: Anterior wall

B3-2: Anterior column (high variety)

B3-3: Anterior column (low variety)

Anterior column injury can be further classified depending upon the number of fragments.

a1: anterior column in 1 fragment.

a2: anterior column in 2 fragments.

a3: anterior column in more than 2 fragments.

Type C: Both columns fracture, complete articular

This fracture divides both columns above the level of the acetabulum through the ilium in the coronal plane, with T extension into the joint. The transverse component divides the ilium above the acetabulum in the coronal plane, whereas the T fracture fractures the posterior column through the joint. Central dislocation is common.

X-ray features include a centrally dislocated femoral head, fracture into the ilium and the characteristic "spur sign" seen best on obturator view represents the transverse limb of the iliac fracture as it passes above the acetabulum. C1-Both column-high variety

C1-1 : Each column a single fragment.

C1-2 : Posterior column is a single fragment. Anterior column in two or more fragments.

C1-3 : A posterior wall fragment is present as well as the posterior column fracture.

C2 : Both column (low variety)-below the iliac crest.

C2-1 : Each column a single fragment.

C2-2 : Posterior column a single fragment. Anterior column has atleast two fragments.

C2-3 : Posterior column has an associated posterior wall fragment.

C3: Both column fractures involving the SI joint. (Iliac fracture enters the SI joint.)

C3-1 Posterior column single fragment.

C3-2 : Posterior column has multiple fragments, anterior column has high fracture.

C3-3 : Posterior column is in multiple fragments and anterior column is low fracture.

 
   References Top

1.Judet R, Judet J, Letournel E. Fractures of the acetabulum - Classification and surgical approaches for open reduction: A preliminary report. J Bone Joint Surg [Am] 1964; 46-A: 1615 - 1646.   Back to cited text no. 1    
2.Tile M. Fractures of Pelvis and acetabulum. Baltimore; Williams & Wilkins. 1964.  Back to cited text no. 2    

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Correspondence Address:
S Dhar
Topiwala National Medical College andBYL Nair Charitable Hospital, Mumbai 400 008
India
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Source of Support: None, Conflict of Interest: None


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