Algorithms in acetabular fracture classifications.

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Abstract

[Indexed for MEDLINE] 9. Cureus. 2025 Oct 23;17(10):e95278. doi: 10.7759/cureus.95278. eCollection 2025 Oct. Letournel-Judet Classification of Acetabular Fractures: A Systematic Review of Reliability and Association With Post-traumatic Arthritis. Sahnon ASA(1)(2), Atef Ramadan Mostafa Ali A(3), Soliman AM(4), Elfatih Elbadri M(5), Haq AU(6), Erenler M(7), Alkhazendar AH(8), H J Alkhazendar J(9), Shehata Abdelmesih S(10), Banjamin S(11). Author information: (1)General Practice, Medical Council of Ireland, Dublin, IRL. (2)General Surgery, Royal College of Surgeons of Edinburgh, Edinburgh, GBR. (3)Emergency, Mubarak Al-Kabeer Hospital, Jabriya, KWT. (4)General Surgery, Faculty of Medicine, Ain-Shams University, Cairo, EGY. (5)Orthopedics, Government Hospital in Khor Fakkan, Sharjah, ARE. (6)Geriatrics, Broomfield Hospital, Chelmsford, GBR. (7)Trauma and Orthopaedics, VM Medical Park Kocaeli, Kocaeli, TUR. (8)Surgery, The Islamic University of Gaza, Gaza, PSE. (9)Trauma and Orthopaedics Surgery, Lister Hospital, East and North Hertfordshire Teaching NHS Trust, Stevenage, GBR. (10)Orthopaedics and Traumatology, Khoula Hospital, Muscat, OMN. (11)General Surgery, Dow University of Health Sciences, Karachi, PAK. Acetabular fractures, though relatively uncommon, represent one of the most complex injuries in orthopaedic trauma due to their impact on hip joint stability and long-term function. The Letournel-Judet classification system remains the most widely accepted framework for describing these fractures, guiding surgical planning, and facilitating communication among clinicians. Despite its extensive use, concerns remain regarding its reproducibility across different observers and its ability to predict clinically significant outcomes such as post-traumatic hip arthritis. This systematic review, conducted according to the PRISMA 2020 guidelines, aimed to evaluate the reliability of the Letournel-Judet classification and its association with post-traumatic arthritis. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library up to August 2025 identified studies that assessed either inter- and intraobserver reliability of the classification or its prognostic correlation with arthritis development. Six studies were included with a sample of 218 patients. Findings demonstrated moderate reliability overall, with improved reproducibility observed among experienced raters and with the adjunct use of computed tomography, structured classification algorithms, or three-dimensional models. Prognostic evidence suggested that posterior wall and transverse fracture variants were associated with higher early risk of arthritis; however, the most consistent determinant of long-term hip function was the quality of anatomic reduction achieved during surgery. This review underscores the importance of integrating advanced imaging and structured interpretive frameworks to improve both the consistency and clinical relevance of acetabular fracture classification. Copyright © 2025, Sahnon et al. DOI: 10.7759/cureus.95278 PMCID: PMC12640466