Is "Transcolumnar" a better Terminology than "Transverse" in Judet-Letournel Classification of Acetabular Fractures?

Sood A

doi:10.5704/moj.2107.002

Abstract

Acetabular fractures are among the most complex and challenging injuries for orthopaedic surgeons. The choice of surgical treatment in acetabular fracture is important for optimal outcomes. It requires an understanding of the precise outline of the fracture by appropriate classification because it is important for decision making. For this purpose, the classification proposed by Judet and Letournel in 1963 remains the gold standard despite its shortcoming, which are attributed to the inclusion of multiple criteria including anatomical, directional and geometrical. This complex classification remains challenging especially to lesser experienced surgeons. In this article, a new method for classification of acetabulum fractures is proposed. It places posterior column with posterior wall fractures to simple fractures instead of complex fractures in Judet and Letournel classification. More importantly the proposed new classification renames “transverse fracture” as “transcolumnar fracture” to better represent anatomical structure rather than morphology. It is expected that by coining the new term “transcolumnar ”it will be easy to understand different types of acetabular fractures. Especially the confusion between “transverse” and “both column fractures” would not be a concern in future.

Highlights

Acetabular fractures are injuries that involve a heterogenous group of population
Hippocrates gave a common terminology “hip dislocations” to injuries around the acetabulum as it was impossible to differentiate between hip dislocation from an acetabulum fracture by clinical examination alone
Greater descriptions of acetabular fractures came to light and the treatment in the first half of 20th century was limited to conservative strategies

Summary

INTRODUCTION

Acetabular fractures are injuries that involve a heterogenous group of population. In a previous study, an annual incidence of 37 pelvic fractures per 100,000 population was reported in the USA and Western Europe and 10% of them involved acetabulum[1]. In 1963, Judet and Letournel published the classical article to describe fractures of the acetabulum, classification and surgical approaches for open reduction. Their classification enhanced the understanding of complex 3D geometry of the fractures and allowed a logical choice of operative procedures[4]. The concepts proposed by Judet and Letournel took a long time before getting wider acceptance Later they published two textbooks in 1981 and 1993, which became very popular and are till today considered to be “the bible” for acetabular surgeons. The Judet-Letournel classification proposed in 1964 and refined in 1974 has stood the test of time and remains the most common and practical way of classifying acetabular fractures. In this article the merits and demerits of the existing classifications are discussed and importantly a newer approach to classify acetabular fractures is proposed

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CONCLUSION