Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability.

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Abstract

[Indexed for MEDLINE] 20. PLoS One. 2025 Feb 6;20(2):e0317932. doi: 10.1371/journal.pone.0317932. eCollection 2025. Characteristic analysis and surgical exploration for acetabular roof fractures: Multicenter retrospective cohort study. Zhang R(1), Yin Y(1), Chen W(1), Zhuang Y(2), Fan S(3), Yi C(4), Lyu G(5), Zheng L(6), Guo X(7), Li M(8), Liu G(9), Hou Z(1), Zhang Y(1). Author information: (1)Department of Orthopaedics, Hebei Medical University Third Hospital, Shijiazhuang, China. (2)Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, China. (3)Department of Orthopaedic, The Third Affiliated Hospital of Southern Medical University, China. (4)Department of trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China. (5)Department of Orthopaedic, Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, China. (6)Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, China. (7)Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China. (8)Department of Traumatic Orthopaedics, The Medical College of Ningbo University Affiliated Ningbo No.6 Hospital, China. (9)Department of Orthopedics, China-Japan Union Hospital of Jilin University, China. BACKGROUND: Acetabular roof was a crucial structure for maintaining the stability of hip joint; however, its important role was not especially emphasized in the Letournel-Judet classification system. Acetabular roof was segmented into the roof column and roof wall in Three-column classification and fracture in this area alone was defined as A3 injury. The purpose of this study was to explore the characteristics and surgical strategy of A3 injury. METHODS: Patients with roof column/wall fractures received surgical management from January 2015 to 2019 January at nine level-1 trauma centers were retrospectively analyzed. Fracture data, surgical incision, operation time, blood loss, fracture healing and relevant complications were recorded to explore fracture characteristics and appropriate surgical strategy. Reduction quality was assessed based on postoperative radiographic examination. Merle d'Aubigné score was used to assess the functional outcome during the follow-up. RESULTS: A total of 60 patients met the inclusion criteria in this study. Mean operation time was 112.83±21.77 min, and mean intraoperative blood loss was 396.67±182.00 ml. Satisfactory reduction quality was obtained in 49 cases (81.67%). All fractures healed well at an average mean of 3.07 months. Satisfactory outcomes were obtained in 46 cases (76.67%), and mean Merle d'Aubigné score was 15.53±1.33 points at the final follow-up. Reduction quality and functional outcome showed no statistical difference in three subtypes (P