Letournel's case series on the diagnosis and surgical management of acetabular fracture nonunions and malunions treated more than 4 months after injury. It establishes the timing framework, choice of approach, and osteotomy technique for restoring joint congruency. Outcomes are reported for 10 nonunions, 44 malunions, and 18 combined lesions.
When you see an acetabular fracture presenting late, the first question is not how to fix the acetabulum but what the femoral head looks like. Letournel's central teaching is that reconstruction restores sphericity, but head wear or necrosis cannot be compensated for and dictates the long-term result.
Use the timing rule at the bedside: under 3 weeks is fresh, and beyond 4 months the fracture is organized and a malunion mandates osteotomy. Match the approach to the lesion. Single-column problems take the Kocher-Langenbeck or ilio-inguinal, while transverse and iliac wing patterns need the extended iliofemoral for complete control.
Recognize two named concepts. Secondary congruence explains why some both-column malunions stay painless for decades, and a fixed-angle painful click points to iliopsoas or obturator internus entrapment in a nonunion. The honest closing message is that these salvage results trail those of fresh fracture care, which is the strongest argument for anatomic fixation early.
Letournel's case series on the diagnosis and surgical management of acetabular fracture nonunions and malunions treated more than 4 months after injury. It establishes the timing framework, choice of approach, and osteotomy technique for restoring joint congruency. Outcomes are reported for 10 nonunions, 44 malunions, and 18 combined lesions.
When you see an acetabular fracture presenting late, the first question is not how to fix the acetabulum but what the femoral head looks like. Letournel's central teaching is that reconstruction restores sphericity, but head wear or necrosis cannot be compensated for and dictates the long-term result.
Use the timing rule at the bedside: under 3 weeks is fresh, and beyond 4 months the fracture is organized and a malunion mandates osteotomy. Match the approach to the lesion. Single-column problems take the Kocher-Langenbeck or ilio-inguinal, while transverse and iliac wing patterns need the extended iliofemoral for complete control.
Recognize two named concepts. Secondary congruence explains why some both-column malunions stay painless for decades, and a fixed-angle painful click points to iliopsoas or obturator internus entrapment in a nonunion. The honest closing message is that these salvage results trail those of fresh fracture care, which is the strongest argument for anatomic fixation early.