This 'Classifications in Brief' paper reviews the Letournel acetabular fracture classification, originally described in 1961 and formalized in 1980 from 647 fractures. It covers how the 10 fracture patterns are defined, how surgical approach selection follows from pattern, and how reliably the system can be applied across imaging modalities and experience levels.
Before Letournel, acetabular fractures were classified only as those associated with posterior or central hip dislocation, and most were treated without surgery — accepting whatever articular congruity resulted. The 5.4% vs 30.7% arthritis data changed that calculus permanently.
When you are reading an acetabular CT, classify the fracture before you plan the approach. The pattern dictates your window: posterior pathology goes through Kocher-Langenbeck, anterior pathology through ilioinguinal, and complex patterns may require both. Getting the classification wrong preoperatively means the wrong incision.
For posterior wall fractures, the classification tells you what broke. Not whether the hip is stable. Always assess stability separately: CT quantification of wall involvement (the 40% threshold) and dynamic stress exam under anesthesia are the tools. A fracture that looks large on imaging may still be stable if the capsule is intact.
Operate within 3 weeks. The paper is explicit: delay beyond this threshold degrades reduction quality. In busy trauma systems where acetabular cases get pushed, this is the number to cite when advocating for timely scheduling.
This 'Classifications in Brief' paper reviews the Letournel acetabular fracture classification, originally described in 1961 and formalized in 1980 from 647 fractures. It covers how the 10 fracture patterns are defined, how surgical approach selection follows from pattern, and how reliably the system can be applied across imaging modalities and experience levels.
Before Letournel, acetabular fractures were classified only as those associated with posterior or central hip dislocation, and most were treated without surgery — accepting whatever articular congruity resulted. The 5.4% vs 30.7% arthritis data changed that calculus permanently.
When you are reading an acetabular CT, classify the fracture before you plan the approach. The pattern dictates your window: posterior pathology goes through Kocher-Langenbeck, anterior pathology through ilioinguinal, and complex patterns may require both. Getting the classification wrong preoperatively means the wrong incision.
For posterior wall fractures, the classification tells you what broke. Not whether the hip is stable. Always assess stability separately: CT quantification of wall involvement (the 40% threshold) and dynamic stress exam under anesthesia are the tools. A fracture that looks large on imaging may still be stable if the capsule is intact.
Operate within 3 weeks. The paper is explicit: delay beyond this threshold degrades reduction quality. In busy trauma systems where acetabular cases get pushed, this is the number to cite when advocating for timely scheduling.