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Open Access 23-10-2024 | Acetabular Fracture | Trauma Surgery

Algorithms in acetabular fracture classifications

Authors: Axel Gänsslen, Jerome Tonetti, Tim Pohlemann

Published in: Archives of Orthopaedic and Trauma Surgery

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Abstract

Acetabular fractures are still challenging fractures. Fracture classification is the basis for understanding these injuries and to gain treatment and to choose a fracture type-based treatment concept. Using a systematic step-wise concept of fracture analysis, based on specific radiographic lines on standard X-rays allow even less experienced surgeons to get a correct classification of the elementary and associated fracture types of Letournel’s classification. Algorithmic analysis of the iliopectineal line, (anterior column involvement), ilioischial line (posterior column involvement), presence of a posterior wall fragment, fracture lines involving the iliac wing and inferior ramus, and the spur sign (representing associated both column fractures) allow for approximately 80–90% correct classifications using standard X-rays when integrating these lines into an algorithm. Especially, T-shaped fractures, ABC and ACPHT fractures may be difficult to classify. Thus, advanced imaging, such as CT scans with multiplanar reconstruction and 3D reconstructions is additionally recommended.
Literature
1.
go back to reference Armstrong J (1948) Traumatic dislocation of the hip joint. J Bone Joint Surg 30B:430–455CrossRef Armstrong J (1948) Traumatic dislocation of the hip joint. J Bone Joint Surg 30B:430–455CrossRef
2.
go back to reference Beaulé P, Dorey F, Matta J (2003) Letorunel classification for acetabular fractures. Assessment of interobserver an dintraobserver reliability. J Bone Joint Surg 85-A:1704–1709CrossRef Beaulé P, Dorey F, Matta J (2003) Letorunel classification for acetabular fractures. Assessment of interobserver an dintraobserver reliability. J Bone Joint Surg 85-A:1704–1709CrossRef
3.
go back to reference Bodanapally U, Dattwyler M (2019) Acetabular fractures: a stepwise approach to identification and classification on 2D computed tomography. Appl Radiol 48:17–23CrossRef Bodanapally U, Dattwyler M (2019) Acetabular fractures: a stepwise approach to identification and classification on 2D computed tomography. Appl Radiol 48:17–23CrossRef
4.
go back to reference Böhler L (1954) Die Technik der Knochenbruchbehandlung. 12.-13. Auflage. Wilhelm Maudrich, Wien Böhler L (1954) Die Technik der Knochenbruchbehandlung. 12.-13. Auflage. Wilhelm Maudrich, Wien
5.
go back to reference Bonnin J (1958) Fractures and related injuries. In: Nigst H (ed) Spezielle Frakturen- und Luxationslehre, Band III, Hüftgelenk und proximaler Oberschenkel 2. Heinemann, London Bonnin J (1958) Fractures and related injuries. In: Nigst H (ed) Spezielle Frakturen- und Luxationslehre, Band III, Hüftgelenk und proximaler Oberschenkel 2. Heinemann, London
6.
go back to reference Brandser E, Marsh J (1998) Acetabular fractures: easier classification with a systematic approach. AJR 171:1217–1228PubMedCrossRef Brandser E, Marsh J (1998) Acetabular fractures: easier classification with a systematic approach. AJR 171:1217–1228PubMedCrossRef
7.
go back to reference Brouwers L, Pull Ter Gunne A, de Jongh M, Maal T, Vreeken R, van der Heijden F, Leenen L, Spanjersberg W, van Helden S, Verbeek D, Bemelman M, Lansink K (2020) What is the value of 3D virtual reality in understanding acetabular fractures? Eur J Orthop Surg Traumatol 30:109–116PubMedCrossRef Brouwers L, Pull Ter Gunne A, de Jongh M, Maal T, Vreeken R, van der Heijden F, Leenen L, Spanjersberg W, van Helden S, Verbeek D, Bemelman M, Lansink K (2020) What is the value of 3D virtual reality in understanding acetabular fractures? Eur J Orthop Surg Traumatol 30:109–116PubMedCrossRef
8.
go back to reference Butler B, Selley R, Cantrell C, Nicolay R, Lawton C, Hashmi S, Carlile K, Stover M (2022) Algorithm improves acetabular fracture radiograph interpretation among inexperienced practitioners. Cureus 14:e21471PubMedPubMedCentral Butler B, Selley R, Cantrell C, Nicolay R, Lawton C, Hashmi S, Carlile K, Stover M (2022) Algorithm improves acetabular fracture radiograph interpretation among inexperienced practitioners. Cureus 14:e21471PubMedPubMedCentral
9.
go back to reference Cauchoix J, Truchet P (1951) Les fractures articulaires de la hanche (col du fémur excepté). Rev Chir Orthop 37:266PubMed Cauchoix J, Truchet P (1951) Les fractures articulaires de la hanche (col du fémur excepté). Rev Chir Orthop 37:266PubMed
10.
go back to reference Clarke-Jenssen J, Ovre S, Roise O, Madsen J (2015) Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous? Arch Orthop Trauma Surg 135:913–918PubMedCrossRef Clarke-Jenssen J, Ovre S, Roise O, Madsen J (2015) Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous? Arch Orthop Trauma Surg 135:913–918PubMedCrossRef
11.
go back to reference Durkee N, Jacobson J, Jamadar D, Karunakar M, Morag Y, Hayes C (2006) Classification of common acetabular fractures: radiographic and CT appearances. AJR 187:915–925PubMedCrossRef Durkee N, Jacobson J, Jamadar D, Karunakar M, Morag Y, Hayes C (2006) Classification of common acetabular fractures: radiographic and CT appearances. AJR 187:915–925PubMedCrossRef
12.
go back to reference Frandsen P, Andersen E, Madsen F, Skjodt T (1988) Garden’s classification of femoral neck fractures: an assessment of inter-observer variation. J Bone Joint Surg 70:588–590CrossRef Frandsen P, Andersen E, Madsen F, Skjodt T (1988) Garden’s classification of femoral neck fractures: an assessment of inter-observer variation. J Bone Joint Surg 70:588–590CrossRef
13.
go back to reference Gänsslen A, Grechenig S, Nerlich M (2015) Kapitel 4: klassifikation der azetabulumfrakturen. In: Gänsslen A, Müller M, Nerlich M (eds) Azetabulumfrakturen. Thieme, Stuttgart, pp 45–55 Gänsslen A, Grechenig S, Nerlich M (2015) Kapitel 4: klassifikation der azetabulumfrakturen. In: Gänsslen A, Müller M, Nerlich M (eds) Azetabulumfrakturen. Thieme, Stuttgart, pp 45–55
14.
go back to reference Gänsslen A, Grechenig S, Nerlich M (2018) Chaper 4: classification of acetabulum fractures. In: Gänsslen A, Lindahl J et al (eds) Avcetabular fractures. Thieme, Stuttgart, pp 39–49 Gänsslen A, Grechenig S, Nerlich M (2018) Chaper 4: classification of acetabulum fractures. In: Gänsslen A, Lindahl J et al (eds) Avcetabular fractures. Thieme, Stuttgart, pp 39–49
15.
go back to reference Hansen E, Marmor M, Matityahu A (2012) Impact of a three-dimensional “hands-on” anatomic teaching module on acetabular fracture pattern recognition by orthopaedic residents. J Bone Joint Surg Am 94:e1771-1777PubMedCrossRef Hansen E, Marmor M, Matityahu A (2012) Impact of a three-dimensional “hands-on” anatomic teaching module on acetabular fracture pattern recognition by orthopaedic residents. J Bone Joint Surg Am 94:e1771-1777PubMedCrossRef
16.
go back to reference Harris J, Coupe K, Lee J, Trotscher T (2004) Acetabular fractures revisited: part 2, a new CT-based classification. AJR 182:1367–1375PubMedCrossRef Harris J, Coupe K, Lee J, Trotscher T (2004) Acetabular fractures revisited: part 2, a new CT-based classification. AJR 182:1367–1375PubMedCrossRef
17.
go back to reference Harris J, Lee J, Coupe K, Trotscher T (2004) Acetabular fractures revisited: Part I, redefinition of the Letournel anterior column. AJR 182:1363–1366PubMedCrossRef Harris J, Lee J, Coupe K, Trotscher T (2004) Acetabular fractures revisited: Part I, redefinition of the Letournel anterior column. AJR 182:1363–1366PubMedCrossRef
18.
go back to reference Hüfner T, Pohlemann T, Gänsslen A, Assassi P, Prokop M, Tscherne H (1999) The value of CT in classification and decision making in acetabulum fractures. A systematic analysis. Unfallchirurg 102:124–131PubMedCrossRef Hüfner T, Pohlemann T, Gänsslen A, Assassi P, Prokop M, Tscherne H (1999) The value of CT in classification and decision making in acetabulum fractures. A systematic analysis. Unfallchirurg 102:124–131PubMedCrossRef
19.
go back to reference Hurson C, Tansey A, O’Donnchadha B, Nicholson P, Rice J, McElwain J (2007) Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. Injury 38:1158–1162PubMedCrossRef Hurson C, Tansey A, O’Donnchadha B, Nicholson P, Rice J, McElwain J (2007) Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. Injury 38:1158–1162PubMedCrossRef
20.
go back to reference Kanthawang T, Vaseenon T, Sripan P, Pattamapaspong N (2020) Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures. Emerg Radiol 27:157–164PubMedCrossRef Kanthawang T, Vaseenon T, Sripan P, Pattamapaspong N (2020) Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures. Emerg Radiol 27:157–164PubMedCrossRef
21.
go back to reference Keltz E, Keshet D, Peled E, Zvi Y, Norman D, Keren Y (2021) Interobserver and intraobserver agreement for Letournel acetabular fracture classification system using 3-dimensional printed solid models. World J Orthop 12:82–93PubMedPubMedCentralCrossRef Keltz E, Keshet D, Peled E, Zvi Y, Norman D, Keren Y (2021) Interobserver and intraobserver agreement for Letournel acetabular fracture classification system using 3-dimensional printed solid models. World J Orthop 12:82–93PubMedPubMedCentralCrossRef
22.
go back to reference Letournel E (1980) Acetabulum fractures: classification and mangement. Clin Orthop 151:81–106 Letournel E (1980) Acetabulum fractures: classification and mangement. Clin Orthop 151:81–106
23.
24.
go back to reference Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer, BerlinCrossRef Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer, BerlinCrossRef
25.
go back to reference Lim P, Stephenson G, Keown T, Byrne C, Lin C, Marecek G, Scolaro J (2018) Use of 3D printed models in resident education for the classification of acetabulum fractures. J Surg Educ 75:1679–1684PubMedPubMedCentralCrossRef Lim P, Stephenson G, Keown T, Byrne C, Lin C, Marecek G, Scolaro J (2018) Use of 3D printed models in resident education for the classification of acetabulum fractures. J Surg Educ 75:1679–1684PubMedPubMedCentralCrossRef
26.
go back to reference Lindsjö U (1985) Classification of ankle fractures: the Lauge-Hansen or AO system? Clin Orthop 199:12–16CrossRef Lindsjö U (1985) Classification of ankle fractures: the Lauge-Hansen or AO system? Clin Orthop 199:12–16CrossRef
27.
go back to reference Ly T, Stover M, Sims S, Reilly M (2011) The use of an algorithm for classifying acetabular fractures: a role for resident education? Clin Orthop Relat Res 469:2371–2376PubMedPubMedCentralCrossRef Ly T, Stover M, Sims S, Reilly M (2011) The use of an algorithm for classifying acetabular fractures: a role for resident education? Clin Orthop Relat Res 469:2371–2376PubMedPubMedCentralCrossRef
28.
go back to reference Mauffrey C, Stacey S, York P, Ziran B, Archdeacon M (2018) Radiographic evaluation of acetabular fractures: review and update on methodology. J Am Acad Orthop Surg 26:83–93PubMedCrossRef Mauffrey C, Stacey S, York P, Ziran B, Archdeacon M (2018) Radiographic evaluation of acetabular fractures: review and update on methodology. J Am Acad Orthop Surg 26:83–93PubMedCrossRef
29.
go back to reference Müller M (1996) CCF: comprehensive classification of fractures: pelvis. New York Müller M (1996) CCF: comprehensive classification of fractures: pelvis. New York
30.
go back to reference O’Toole R, Cox G, Shanmuganathan K, Castillo R, Turen C, Sciadini M, Nascone J (2010) Evaluation of computed tomography for determining the diagnosis of acetabular fractures. J Orthop Trauma 24:284–290PubMedCrossRef O’Toole R, Cox G, Shanmuganathan K, Castillo R, Turen C, Sciadini M, Nascone J (2010) Evaluation of computed tomography for determining the diagnosis of acetabular fractures. J Orthop Trauma 24:284–290PubMedCrossRef
31.
go back to reference Ohashi K, El-Khoury GY, Abu-Zahra K, Berbaum K (2006) Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary? Radiology 241:386–391PubMedCrossRef Ohashi K, El-Khoury GY, Abu-Zahra K, Berbaum K (2006) Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary? Radiology 241:386–391PubMedCrossRef
32.
go back to reference OTA (1996) Fracture and dislocation compendium. J Orthop Trauma 10:71–75 OTA (1996) Fracture and dislocation compendium. J Orthop Trauma 10:71–75
33.
go back to reference Petrisor B, Bhandari M, Orr R, Mandel S, Kwok D, Schemitsch E (2003) Improving reliability in the classification of fractures of the acetabulum. Arch Orthop Trauma Surg 123:228–233PubMedCrossRef Petrisor B, Bhandari M, Orr R, Mandel S, Kwok D, Schemitsch E (2003) Improving reliability in the classification of fractures of the acetabulum. Arch Orthop Trauma Surg 123:228–233PubMedCrossRef
34.
go back to reference Polesello G, Nunes M, Azuaga T, de Queiroz M, Honda E, Ono N (2012) Comprehension and reproducibility of the Judet and Letournel classification. Acta Ortop Bras 20:70–74PubMedPubMedCentralCrossRef Polesello G, Nunes M, Azuaga T, de Queiroz M, Honda E, Ono N (2012) Comprehension and reproducibility of the Judet and Letournel classification. Acta Ortop Bras 20:70–74PubMedPubMedCentralCrossRef
35.
go back to reference Prevezas N, Antypas G, Louverdis D, Konstas A, Papasotiriou A, Sbonias G (2009) Proposed guidelines for increasing the reliability and validity of Letournel classification system. Injury 40:1098–1103PubMedCrossRef Prevezas N, Antypas G, Louverdis D, Konstas A, Papasotiriou A, Sbonias G (2009) Proposed guidelines for increasing the reliability and validity of Letournel classification system. Injury 40:1098–1103PubMedCrossRef
36.
go back to reference Riouallon G, Sebaaly A, Upex P, Zaraa M, Jouffroy P (2018) A new, easy, fast, and reliable method to correctly classify acetabular fractures according to the Letournel system. JB JS Open Access 3:e0032PubMedPubMedCentralCrossRef Riouallon G, Sebaaly A, Upex P, Zaraa M, Jouffroy P (2018) A new, easy, fast, and reliable method to correctly classify acetabular fractures according to the Letournel system. JB JS Open Access 3:e0032PubMedPubMedCentralCrossRef
37.
go back to reference Rowe C, Lowell J (1961) Prognosis of fractures of the acetabulum. JBJS 43-A:30–59CrossRef Rowe C, Lowell J (1961) Prognosis of fractures of the acetabulum. JBJS 43-A:30–59CrossRef
38.
go back to reference Scheinfeld M, Dym A, Spektor M, Avery L, Dym R, Amanatullah D (2015) Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics 35:555–577PubMedCrossRef Scheinfeld M, Dym A, Spektor M, Avery L, Dym R, Amanatullah D (2015) Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics 35:555–577PubMedCrossRef
39.
go back to reference Sebaaly A, Riouallon G, Zaraa M, Upex P, Marteau V, Jouffroy P (2018) Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop 42:1957–1965PubMedCrossRef Sebaaly A, Riouallon G, Zaraa M, Upex P, Marteau V, Jouffroy P (2018) Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop 42:1957–1965PubMedCrossRef
40.
go back to reference Shaath M, Avilucea F, Lim P, Routt M (2022) A new algorithm for classifying acetabular fracture patterns on three-dimensional computed tomography reconstructions markedly improves residents’ ability to correctly classify fractures. J Am Acad Orthop Surg 30:79–83PubMed Shaath M, Avilucea F, Lim P, Routt M (2022) A new algorithm for classifying acetabular fracture patterns on three-dimensional computed tomography reconstructions markedly improves residents’ ability to correctly classify fractures. J Am Acad Orthop Surg 30:79–83PubMed
41.
go back to reference Tazeabadi S, Noroozi S, Salehzadeh M, Bahardoust M, Farahini H, Hajializade M, Yeganeh A (2020) Evaluation of Judet view radiographs accuracy in classification of acetabular fractures compared with three-dimensional computerized tomographic scan: a retrospective study. BMC Musculoskelet Disord 21:405PubMedPubMedCentralCrossRef Tazeabadi S, Noroozi S, Salehzadeh M, Bahardoust M, Farahini H, Hajializade M, Yeganeh A (2020) Evaluation of Judet view radiographs accuracy in classification of acetabular fractures compared with three-dimensional computerized tomographic scan: a retrospective study. BMC Musculoskelet Disord 21:405PubMedPubMedCentralCrossRef
42.
go back to reference Thomsen N, Overgaard S, Olson L, Hansen H, Nielsen S (1991) Observer variation in the radiographic classification of ankle fractures. J Bone and Joint Surg 73-B:676–678CrossRef Thomsen N, Overgaard S, Olson L, Hansen H, Nielsen S (1991) Observer variation in the radiographic classification of ankle fractures. J Bone and Joint Surg 73-B:676–678CrossRef
43.
go back to reference Tile M, Helfet D, Kellam J (2003) Fractures of the pelvis and acetabulum. Williams & Wilkins, Baltimore Tile M, Helfet D, Kellam J (2003) Fractures of the pelvis and acetabulum. Williams & Wilkins, Baltimore
44.
go back to reference Visutipol B, Choptangsin P, Ketmalasiri B, Pattarbanjird N, Varodopun N (2000) Evaluation of Letournel and Judet classification of acetabular fracture with plain radiographs and three-dimensional computerized tomographic scans. J Orthop Surg 8:33–37CrossRef Visutipol B, Choptangsin P, Ketmalasiri B, Pattarbanjird N, Varodopun N (2000) Evaluation of Letournel and Judet classification of acetabular fracture with plain radiographs and three-dimensional computerized tomographic scans. J Orthop Surg 8:33–37CrossRef
45.
go back to reference Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85-A(2):278–286CrossRef Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85-A(2):278–286CrossRef
Metadata
Title
Algorithms in acetabular fracture classifications
Authors
Axel Gänsslen
Jerome Tonetti
Tim Pohlemann
Publication date
23-10-2024
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-024-05599-6