Acetabular Fractures — Classification, Diagnosis, Surgical Stabilization and Approaches
DNB Orthopaedics • October 2023 • Paper IV • Question 10 • 10 Marks [3+2+2+3]
Introduction
Acetabular fractures are intra-articular fractures of the socket of the hip and usually result from high-energy trauma in younger adults, although low-energy fragility fractures are increasingly encountered in elderly patients.
The goals of treatment are to restore: hip congruity, articular surface, acetabular columns, stability of the femoral head and a functional pain-free joint.
The most important determinant of outcome after reconstruction is the quality of articular reduction, provided the femoral head and cartilage remain viable.
Surgical Anatomy — Column Concept
Judet and Letournel described the acetabulum as being formed by two structural columns.
Anterior Column
Extends from the iliac crest through the anterior acetabulum and superior pubic ramus toward the pubic symphysis.
Posterior Column
Extends from the greater sciatic notch through the posterior acetabulum to the ischial tuberosity.
Understanding whether one or both columns are disrupted is fundamental to classification, approach selection and fixation.
A. Classification of Acetabular Fractures [3 Marks]
Judet–Letournel Classification
This is the standard and most widely used classification. It divides fractures into:
Five Elementary Fracture Types
- Posterior wall
- Posterior column