This 1964 landmark paper by Judet, Judet, and Letournel introduces the two-column anatomical concept of the acetabulum and a classification of fractures based on it. The study describes 173 acetabular fractures, defines four elementary fracture types, and outlines matched surgical approaches for open reduction. Long-term outcomes are deferred, but the authors conclude that open reduction is superior to closed treatment for displaced fractures.
Every acetabular fracture case you scrub on traces its conceptual framework to this paper. Before Judet and Letournel, acetabular fractures had no systematic anatomy-based classification, and open reduction was rarely attempted because the surgical approaches had not been codified.
When you read an acetabular CT and identify a fracture as "posterior wall," "anterior column," or "both-column with central dislocation," you are applying this paper's framework directly. The classification you use today is Letournel's 10-type expansion (1980) of the four elementary types defined here.
The key decision rule from this paper: fracture type determines approach. Posterior wall and ilioischial column fractures go posterior (Kocher-Langenbeck). Iliopubic column fractures go anterior (ilioinguinal or iliocrural). Transverse fractures are decided by the associated injury pattern.
The paper also establishes the AVN principle that still governs acute management: the dislocation drives AVN risk, not the fracture itself. Reduce the dislocation urgently — even if definitive fixation must wait days for patient stabilization.
This 1964 landmark paper by Judet, Judet, and Letournel introduces the two-column anatomical concept of the acetabulum and a classification of fractures based on it. The study describes 173 acetabular fractures, defines four elementary fracture types, and outlines matched surgical approaches for open reduction. Long-term outcomes are deferred, but the authors conclude that open reduction is superior to closed treatment for displaced fractures.
Every acetabular fracture case you scrub on traces its conceptual framework to this paper. Before Judet and Letournel, acetabular fractures had no systematic anatomy-based classification, and open reduction was rarely attempted because the surgical approaches had not been codified.
When you read an acetabular CT and identify a fracture as "posterior wall," "anterior column," or "both-column with central dislocation," you are applying this paper's framework directly. The classification you use today is Letournel's 10-type expansion (1980) of the four elementary types defined here.
The key decision rule from this paper: fracture type determines approach. Posterior wall and ilioischial column fractures go posterior (Kocher-Langenbeck). Iliopubic column fractures go anterior (ilioinguinal or iliocrural). Transverse fractures are decided by the associated injury pattern.
The paper also establishes the AVN principle that still governs acute management: the dislocation drives AVN risk, not the fracture itself. Reduce the dislocation urgently — even if definitive fixation must wait days for patient stabilization.