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Radiographics. 2015 Mar-Apr;35(2):555-77. doi: 10.1148/rg.352140098.

Acetabular fractures: what radiologists should know and how 3D CT can aid classification.

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  • 1From the Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467 (M.H.S., R.J.D.); Albert Einstein College of Medicine, Bronx, NY (A.A.D.); Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S.); Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (L.L.A.); and Department of Orthopedic Surgery, Stanford University, Palo Alto, Calif (D.F.A.).

Abstract

Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article.

PMID:
25763739
DOI:
10.1148/rg.352140098
[PubMed - indexed for MEDLINE]
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