Judet-Letournel Classification Research Articles

A new classification for quadrilateral plate fracture of acetabulum

BackgroundRecently, quadrilateral plate (QLP) fractures of acetabulum have attracted increasing attention. However, evidence for the appropriate classification of QLP fractures is still lacking, making it difficult to understand and manage these fractures. This study aimed to introduce a new classification for QLP fractures and evaluate its reproducibility. MethodsA series of 1101 consecutive patients with acetabular fractures from 8 level-I trauma centers were enrolled in this study. All patients underwent preoperative radiograph and computed tomography imaging. QLP fractures were identified and classified using the new and Judet-Letournel classification system. The inter- and intra-observer reliabilities (kappa coefficients, κ) of these two systems were investigated by 4 observers. Furthermore, surgical approaches and fixation methods for each fracture type are described. ResultsIn total, 243 (243/1101, 22%) patients with QLP fractures were identified and included in this analysis. The mean κ value of the intra-observer reliability was 0.84 (range, 0.763−0.919) for the new classification, indicating excellent agreement, and the inter-observer reliability was 0.762 (range, 0.625−0.876), indicating substantial agreement. The values were 0.649 (range, 0.523−0.708) and 0.584 (0.497−0.646), respectively, according to the Judet-Letournel classification. Six cases (6/243, 2.5%) could not be classified using the Judet-Letournel classification. The selection of surgical approaches and fixation methods depends on the fracture type; however, an anterior intra-pelvic approach and buttressing fixation using the plate or screw are preferred for QLP fractures. ConclusionThis study presents a new classification for QLP fractures, showing higher intra- and inter-observer reliabilities than those obtained using the Judet-Letournel classification. This allowed us to obtain an in-depth and comprehensive understanding of QLP fractures. Additionally, the new classification might guide further studies on surgical strategies for QLP fractures. Level of EvidenceLevel II

Clinical Outcomes of the Modified Stoppa Combined with Iliac Fossa Approach for Complex Acetabular Fractures: A Medium- and Long-term Retrospective Study.

ObjectiveThe modified Stoppa combined with iliac fossa approach has gained increasing popularity. Although early clinical outcomes have been satisfactory, extensive long‐term clinical outcomes are relatively scarce. The purpose of this study was to evaluate the medium‐ and long‐term outcomes of this approach for complex acetabular fractures.MethodsThis was a retrospective study involving 57 patients with complex acetabular fractures from January 2009 to January 2016. All fractures were treated with the modified Stoppa combined with iliac fossa approach. Follow‐up was at least 5 years. Primary outcome measures, including quality of reduction and clinical outcomes, were recorded by an independent observer. Secondary outcome measures included time to surgery, surgical time, intraoperative blood loss, and perioperative complications.ResultsFifty‐seven patients (range, 18–80 years) included 46 males and 11 females. There were 32 cases on the left side and 25 cases on the right side. The most common associated injury was pulmonary contusion. According to the Judet–Letournel classification, there were 27 both‐column fractures, 16 anterior column with posterior hemitransverse fractures and 14 T‐type fractures. The average time from injury to surgery was 7.3 days. The average intraoperative blood loss and transfusion were 750.9 ml and 564.3 ml, respectively. All fractures healed within 6 months after surgery. The average follow‐up time was 7.7 years, and there was no loss of follow‐up. The quality of reduction was graded as anatomical in 23 cases (40.4%), imperfect in 22 cases (38.6%), and poor in 12 cases (21.0%). According to grading system of Merle d’ Aubigne and Postel, clinical outcomes at 1 year follow‐up were excellent in 17 cases (29.8%), good in 25 cases (43.9%), fair in four cases (7.0%), and poor in 11 cases (19.3%). The excellent and good rate was 73.7% and the difference was not statistically significant compared with the clinical outcomes at the last follow‐up. Intraoperative complications included four cases of obturator nerve injury and two cases of vascular injury. Postoperative complications included one case of wound delayed healing, two cases of deep vein thrombosis, two cases of avascular necrosis of femoral head, three cases of heterotopic ossification and five cases of post‐traumatic arthritis. Only one of these patients underwent reoperation for femoral head necrosis.ConclusionsThe modified Stoppa combined with iliac fossa approach can achieve satisfactory reduction quality and hip function. It might be a valuable alternative to the ilioinguinal approach for the surgical management of acetabular fractures.

Prospective study of fluoroscopy guided cannulated screw fixation in pelvic ring and acetabulum fractures through percutaneous or mini incision technique

Open reduction and Internal fixation of pelvis and acetabulum fractures have required extensive surgical exposure of the deep structures of the pelvis, with problems of wound healing, damage to major vessels or nerves and infection. To overcome this percutaneous fixation of the pelvic and acetabulum fracture receiving increasing attention. Percutaneous techniques may offer advantage of soft tissue planes remain intact, which ease later arthroplasty of the hip if necessary. Percutaneous techniques may be an ideal treatment for pelvic and acetabulum in polytrauma. Advantages for percutaneous screw fixation of pelvic and acetabular fractures in these studies include less soft tissue injury, less blood loss, and a lower rate of infection. Furthermore, early weight bearing ambulation will be possible with percutaneous screw fixation. Neurovascular injuries, internal organ injuries, screw misplacement, and screw fracture are some potential complications of this technique. Aim: To investigates the clinical and radiological outcomes and complications of percutaneous screw fixation of Pelvic ring fracture and acetabulum fracture. Study design: Hospital based prospective type of observational study. Materials and Methods: After taking clearance from ethical committee a total 54 patient operated for 62 fractures and 95 cc screw were inserted through different percutaneous and mini incision (windows) approach for fracture of pelvis and acetabulum were operated based on preoperative CT SCAN in between January 2019 to November 2020. The pelvis and acetabulum fractures were classified based on young - burgess and judet-letournel classification system. The outcome variables for radiological outcome was evaluated by matta radiological score and functional outcome were evaluated by Harris hip score and Majeed pelvis score at 6 and 12 months follow up. Results: In post-operative follow up patient were started with active range of motion without weight bearing for 3 months then partially weight bear as tolerated after 3 months the respective functional Harris hip score, Majeed score were obtained at 6 and 12 months of follow up with p value of

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

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.

Acetabular fractures: epidemiological, lesional, therapeutic and evolutionary aspects

<p class="abstract"><strong>Background:</strong> Fractures of the acetabulum are serious because they affect a deep, load-bearing joint that is difficult to repair surgically at first. They occur in a context of polytrauma. The aim of our work is to study the epidemiological, lesional, therapeutic and evolutionary aspects of acetabulum fractures.</p><p class="abstract"><strong>Methods: </strong>This is a 5-year retrospective study from January 2012 to December 2016 including 45 patients treated for acetabulum fracture.</p><p class="abstract"><strong>Results: </strong>45 patients including 38 men and 7 women with a mean age of 36 years (extremes 18 and 74). The circumstances of occurrence were dominated by road traffic accidents with 42 cases (93.3%).</p><p class="abstract">According to the Judet-Letournel classification, we observed 28 elementary fractures (16 posterior wall fractures, 11 posterior column fractures, 1 anterior column fracture) and 17 complex fractures (7 posterior column and posterior wall fractures, 6 transverse and posterior wall fractures, 3 posterior and anterior column fractures, 1 anterior column and posterior hemi-transverse fracture). The association of a dislocation with an acetabulum fracture was found in 32 cases. Associated lesions (fractures) were observed in 23 patients. One case of associated TCE was noted. Treatment was orthopedic in 18 patients, surgical in 18 patients and functional in 9 patients. According to the Matta criteria we obtained after treatment 46.7% good reduction, 51.1% satisfactory and 2.2% unsatisfactory reduction. According to the Postel-Merle D'Aubigné rating, 16 patients obtained excellent results with overall 93.3% satisfactory results. The complications found were coxarthrosis (15 cases), para-articular ossification (2 cases) and vicious callus (1 case).</p><p class="abstract"><strong>Conclusions:</strong> The treatment of acetabulum fractures depends on the type of fracture, the age and activities of the patients. Orthopedic, surgical as well as functional treatment can give good acetabular reconstructions and functional results.</p>

Comparison of clinical and radiological outcomes after posterior acetabular fractures in patients younger and older than 40 years old

Aim: This study aimed to evaluate and compare the clinical and radiological outcomes of patients aged >40 years and ≤40 years old, who underwent open reduction internal fixation for posterior fracture and/or fracture dislocation of the acetabulum.Material and Methods: A total of 52 patients who underwent surgical treatment for posterior acetabular fracture and/or fracture dislocation between June 2006 and October 2013 were included in this study. The patients were divided into the following 2 groups: group I, patients aged 40 years (n = 27; mean age, 53.3; mean follow-up period, 36.8 months). The Judet–Letournel classification system was used in the radiological classification of acetabular fractures. Clinical and radiological evaluations were performed using the modified Merle D’Aubigne evaluation score and the criteria developed by Matta, respectively. In addition, radiological evaluation for heterotopic ossification was performed according to the Brooker scoring system.Results: No significant difference in the quality of reduction and clinical and radiological findings was found between the two groups (p>0.05). The modified Merle D’Aubigne clinical outcome distribution and the distribution of Matta radiological results in groups I and II did not differ significantly (p>0.05 and p>0.05, respectively). Moreover, no significant difference in the development of postoperative heterotopic ossification was observed between the groups (p>0.05). Conclusion: Clinical and radiological outcomes are not significantly different between patients younger and those older than 40 years. Nevertheless, the clinical outcome scores are better in patients aged ≤40 years.

Actual features of express diagnostic of acetabular fractures. Part II. Complex fractures diagnostic algorithm

Authors shows rational algorithm of choosing fracture type according to JudetLetournel classification. Case presentation is based on complex (associated) fracture types.

Three-Column Classification for Acetabular Fractures: Introduction and Reproducibility Assessment.

The Judet-Letournel classification has been widely used to diagnose acetabular fractures since it was proposed. However, there has been growing evidence of incompleteness and comprehension difficulty in this classification, which may adversely affect its clinical use. The purposes of this study were to introduce a novel 3-column classification system for acetabular fractures and to evaluate its reliability and reproducibility. A total of 1,028 patients with acetabular fractures, who had undergone surgical treatment from June 2011 to January 2017 in 7 level-I trauma centers, were recruited into this study. Preoperative radiographs and computed tomographic (CT) scans were conducted for each patient. To evaluate the reproducibility of the 3-column classification system for acetabular fractures, the interobserver and intraobserver reliability (kappa coefficient, κ) of this classification system compared with those of the Judet-Letournel classification system was investigated by 4 observers. A total of 209 patients (20.33%) could not be classified by the Judet-Letournel classification, and 3 cases (0.29%) could not be classified by the novel 3-column classification. The mean κ value of the interobserver reliability for the Judet-Letournel classification was 0.591 (range, 0.508 to 0.681), indicating moderate agreement, whereas the mean κ value was 0.735 (range, 0.594 to 0.930), indicating substantial agreement, when using the 3-column classification. The mean κ value for the intraobserver reliability was 0.751 (range, 0.708 to 0.793) for the Judet-Letournel classification and 0.909 (range, 0.792 to 0.957) for the 3-column classification. The 3-column classification, based on the anatomic character of the acetabulum, showed higher interobserver and intraobserver reliability than the Judet-Letournel classification. Additionally, certain fracture patterns in the 3-column classification scheme generally correlated with surgical approaches. This novel classification system may be used as a supplement to the traditional Judet-Letournel classification system. The 3-column concept of the acetabulum proposed in this study is helpful to master acetabular fractures for less experienced surgeons. The novel classification system could assist with acetabular fracture diagnosis and the choice of surgical approaches.

What is the value of 3D virtual reality in understanding acetabular fractures?

Acetabular fractures are difficult to classify owing to the complex three-dimensional (3D) anatomy of the pelvis. 3D printing helps to understand and reliably classify acetabular fracture types. 3D-virtual reality (VR) may have comparable benefits. Our hypothesis is that 3D-VR is equivalent to 3D printing in understanding acetabular fracture patterns. A total of 27 observers of various experience levels from several hospitals were requested to classify twenty 3D printed and VR models according to the Judet-Letournel classification. Additionally, surgeons were asked to state their preferred surgical approach and patient positioning. Time to classify each fracture type was recorded. The cases were randomized to rule out a learning curve. Inter-observer agreement was analyzed using Fleiss' kappa statistics (κ). Inter-observer agreements varied by observer group and type of model used to classify the fracture: medical students: 3D print (κ = 0.61), VR (κ = 0.41); junior surgical residents: 3D print (0.51) VR (0.54); senior surgical residents: 3D print (0.66) VR (0.52); junior surgeons: 3D print (0.56), VR (0.43); senior surgeons: 3D print (κ = 0.59), VR (κ = 0.42). Using 3D printed models, there was more agreement on the surgical approach (junior surgeons κ = 0.23, senior surgeons κ = 0.31) when compared with VR (junior surgeons κ = 0.17, senior surgeons 0.25). No difference was found in time used to classify these fractures between 3D printing and VR for all groups (P = 1.000). The Judet-Letournel acetabular classification stays difficult to interpret; only moderate kappa agreements were found. We found 3D-VR inferior to 3D printing in classifying acetabular fractures. Furthermore, the current 3D-VR technology is still not practical for intra-operative use.

Express diagnostic of acetabular fractures. Part I. X-ray associated anatomy, simple fractures diagnostic algorithm (part I)

This article describes main radiologic signs of bony structures that form acetabulum. The methods of poly projection x-rays study and evaluation of it are described. Also, authors show rational algorithm of choosing fracture type according to JudetLetournel classification. Case presentation is based on simple fracture types.

A study on fracture lines of the quadrilateral plate based on fracture mapping

BackgroundQuadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance.MethodsCT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines.ResultsThe fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines.ConclusionsThe fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.

The lateral-rectus approach combined with preoperative simulation assisted by 3D printing for treatment of acetabular fractures in the elderly

Objective To explore the efficacy of the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing for treatment of acetabular fractures in the elderly. Methods A total of 52 elderly patients with acetabular fracture were admitted to Department of Orthopaedics and Trauma, The Third Affiliated Hospital to Southern Medical University from January 2014 to December 2017. They were 36 males and 16 females, with an average age of 71.6 years (from 65 to 88 years). According to the Judet-Letournel classification, there were 5 anterior column fractures, 6 transverse fractures, 18 anterior and posterior hemi-transverse fractures, and 23 both-column fractures. For all cases a preoperative surgical simulation was implemented based on their 3D-printed acetabular models. A pre-bent reconstruction plate or a custom acetabular aliform plate was placed to fixate the fracture after reduction via the anterior lateral-rectus approach. The reduction quality, healing time, function of affected hip and complications were recorded. Results The operation time for this cohort ranged from 85 to 138 min (average, 102 min); the intraoperative bleeding ranged from 280 to 750 mL(average, 520 mL). Perioperatively, implant failure, wound infection or symptomatic lower extremity phlebothrombosis was observed in none of the patients. According to the Matta radiological evaluation, the postoperative reduction was rated as excellent in 40 cases, as good in 7 and as poor in 5 (an excellent and good rate of 90.4%). All cases were followed up for 6 to 18(mean, 10.6 months). All the acetabular fractures united after 8 to 20 weeks (average, 12 weeks). According to the modified Merle d’Aubigne-Postal scoring at the final follow-up, the function of affected hip was categorized as excellent in 29 cases, as good in 12 and as fair in 11 (an excellent and good rate of 78.8%). Walking pain was experienced by 5 patients 6 months after operation, diagnosed by imaging examination as traumatic arthritis of the hip joint. Follow-ups observed no such complications as screw loosening or heterotopic ossification. Conclusion In the treatment of acetabular fractures in the elderly, the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time and reduce such complications as screw loosening caused by osteoporosis. Key words: Acetabulum; Fractures, bone; 3D-printed technology; Aged; Surgical approach

Application of customized variable-angle locking acetabular wing plates in treatment of acetabular fractures in the elderly via the lateral-rectus approach

Objective To evaluate clinical efficacy and surgical techniques of customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly through the lateral-rectus approach. Methods Data of 11 elder patients of complex acetabular fractures (mean age 75 y, range: 60-93 y; 8 males, 3 females) admitted to our department from March 2016 to March 2017 were retrospectively analyzed. According to Judet-Letournel classification of acetabular fractures, there were 2 cases of anterior column and posterior hemitransverse fractures, 9 cases of both-column fractures. The customized variable-angle locking acetabular wing plates were designed by mimics software and then produced before surgery. During the operation, the customized variable-angle locking acetabular wing plate was applied to reduction and fixation via the anterior lataral-rectus approach. The effect of fracture reduction was assessed by Matta's criteria. The clinical effect was assessed by Harris Hip score and the modified Merle d' Aubigne-Postal score at the 6th month of postoperative follow-up. Results The average time of designing and producing customized variable-angle locking acetabular wing plates was 4 d (3-5 d), the average operation time was 95 min (45-150 min), and the average intraoperative bleeding was 600 ml (250-1 400 ml). All patients were followed up, with an average follow-up of 18 m (6-24 m). All fractures were healed, with an average healing time of 8 weeks (6-12 weeks). Reduction quality: excellent in 8 cases, good in 2 cases, poor in 1 case, with an overall excellent and good rate of 90.9%. The result of Harris Hip scoring: excellent in 7 cases, good in 3 cases, and acceptable in 1 case, with a total excellent and good rate of 90.9%; Modified Merle d' Aubigne-Postal soring: excellent in 6 cases, good in 3 cases, and acceptable in 2 cases, with an overall excellent and good rate of 81.8%. There were 2 cases of obturator nerve injury, 1 case of fat liquefaction of incision, 3 cases of traumatic hip arthritis. During the follow-up, no complications such as ectopic ossification, plate fracture and screw loosening were found. Conclusion The customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly via the lateral-rectus approach can achieve satisfactory reduction and firm fixtation. Key words: Acetabulum; Fracture; Aged; Fracture fixation, internal

The incidence and clinical significance of corona mortis vessel

Objective To explore the incidence and clinical significance of corona mortis vessels. Methods From December 2015 to December 2017, 48 patients with pelvic acetabular fractures were treated with the Stoppa approach, including 36 males and 12 females, aged 30 to 67 years, with an average age of 47.2±8.2 years. There were 52 sides of hemipelvis in the all including 44 cases of unilateral pelvic acetabular fractures and 4 cases of bilateral pelvic acetabular fractures. In the 48 patients, there were 6 pelvic fractures, 40 acetabular fractures and 2 pelvic combined with acetabular fractures. According to Judet-Letournel classification: there were 6 cases of anterior column fracture, 4 cases of anterior column with anterior wall fracture, 2 cases of anterior column with posterior transverse fracture, 4 cases of transverse fracture, 6 cases of T shape fracture and 20 cases of double column fracture. According to Tile classification, there were 2 cases of B1 type, 2 cases of B3 type, 2 cases of C1 type, and 2 cases of C2 type. The time from injury to surgery was 5 to 16 days, with an average of 8.3±2.8 days. All patients were treated with the Stoppa approach for reduction and fixation. The incidence, number and type of corona mortis vessels across the superior pubic branch, and the diameter and the distance between the vessels and the pubic symphysiswere detected and recorded. Results In the 52 hemi pelvis, there were 46 sides with an anastomotic blood vessel, and no anastomotic blood vessel was found in 6 sides, with the incidence of corona mortis vessels of 88.5% (46/52). Among them, 36 cases were venous type, with the incidence of 78.3% (36/46); 8 cases were arterial type, with the incidence of 17.4% (8/46); 2 cases were mixed type, with the incidence of 4.3%(2/46); corona mortis venous blood vessel diameter was 1.8-3.7 mm, with an average of 2.9±0.5 mm; arterial blood vessel diameter was 2.4-3.0 mm, with an average of 2.7±0.3 mm; the distance between the vessels and the pubic symphysis was 48-71 mm, with an average of 56.9±5.8 mm. Conclusion The corona mortis vessels are common, with the incidence through Stoppa approach about 88.5%. In the clinical treatment of pelvic acetabular fractures, we should pay attention to careful separation of pubic branches exposed by the Stoppa approach, especially when using ilioinguinal approach to avoid corona mortis vessels injury and haemorrhage. Key words: Pelvis; Acetabulum; Fractures, bone; Blood vessels

The Value of 3D Printed Models in Understanding Acetabular Fractures

Abstract Acetabular fractures are complex and difficult to classify. Although the Judet–Letournel classification is designed to increase the understanding of acetabular fractures, it remains prone ...

Mid-term functional results of surgically treated acetabulum fractures

The aim of the study was to evaluate the type of trauma, additional injury, age, additional diseases, need for ICU and blood transfusion, postoperative complications, mid-term patient satisfaction and hip functions of the patients who underwent surgical treatment for acetabulum fracture in our clinic. A total of 17 patients (15 males, 2 females, mean age 40,7 years ) who admitted to the emergency department between 2013 and 2016, and treated surgically due to acetabulum fractures were included in the study. According to Judet Letournel classification, 7 anterior wall fractures, 4 anterior column fractures, 3 posterior column fractures and 3 both column fractures were determined. Mean hospital stay was 14.5 days (range 3-45 days) and mean follow-up was 26 months (14 to 57 months). ICU needed in 3 (17.6%) cases, mean stay was 10.3 days (range 1-29 days). 6 (35.2%) patients required blood transfusion, mean amount was 4.1 units (range 2-6 units). Harris hip scores were excellent - good in 12 cases (70.5%) and 5 cases (29.5%) had moderate - poor results at 12th month. There was no statistically significant relationship between severity of trauma, type of injury, age, additional diseases, intensive care and blood transfusion requirements, postoperative complications and patient satisfaction (p> 0.05). In selected acetabular fracture cases with proper planning according to fracture type, in early period, surgery may lead to satisfactory results in terms of patient satisfaction and hip functions.

Treatment of elderly patients with acetabular fracture involving medial displacement of the quadri-lateral surface using internal fixation with dynamic anterior plate-screw system for quadrilateral area

Objective To investigate the clinical efficacy of open reduction and internal fixation with dynamic anterior plate-screw system for quadrilateral area (DAPSQ) in the treatment of elderly patients with acetabular fracture involving medial displacement of the quadrilateral surface. Methods Between January 2007 and December 2014, a series of 18 senile patients with acetabular fractures involving medial displace-ment of the quadrilateral surface were treated at our department. They were 13 men 5 women, with a mean age 67.8 years (range, from 61 to 78 years). By the Judet-Letournel classification, there were 4 anterior column fractures, 5 anterior column plus posterior hemitransverse fractures, 8 double column fractures and one T-shaped fracture. The delay from injury to surgery averaged 6.5 days. All were treated with the technique of DAPSQ. Screw internal fixation of the quadrilateral area followed plate moulding via a single ilioinguinal ap-proach. Fixation with lag screws for the posterior column was added if necessary. Results The 18 pa-tients were followed up for 12 to 35 months (mean, 26 months). By the Matta criteria for fracture reduction, 9 cases were rated as excellent, 6 as good and 3 as poor. Bone healing was achieved within 2 to 4 months (mean, 3.5 months). By the modified Merle d’Aubigne & Postel criteria, the affected hips scored 9 to 18 points (mean, 16.3 points) at the final follow-ups, giving 7 excellent, 7 good, 2 fair and 2 poor cases. By the Harris evaluation, the affected hips scored 58 to 98 points (mean, 87.6 points), giving 7 excellent, 8 good, one fair and 2 poor cases. The postoperative complications included urinary tract infection in one, lesion of lateral femoral cutaneous nerve in one, heterotopic ossification (Brooker Grade Ⅰ ) in one, and traumatic osteoarthritis in 5 cases 2 of whom had to receive total hip arthroplasty. Conclusion The technique of DAPSQ is suitable for the treatment of acetabular fractures involving medial displacement of the quadrilateral surface in elderly patients, because it can provide and maintain stable fixation of the fracture in the quadri-lateral area and preserve hip joint function, leading to fine outcomes. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Aged

Minimally invasive percutaneous plate osteosynthesis for the treatment of acetabulum anterior column fracture with intact true pelvic brim

To discuss feasibility and clinical effects of minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim. From May 2013 to December 2015, 8 patients with acetabulum anterior column fracture with intact true pelvic brim were reviewed retrospectively. According to Judet-Letournel classification, all were simple unstable acetabulum anterior column fracture. Among them, there were 5 males and 3 females with an average age of 42.8 years old ranging from 22 to 63. The injury was caused by crush in 4 cases, smash of heavy object in 3 cases, and falling down in 1 case. The time from injury to operation was ranged from 5 to 19 days with an average of 9.5 days. Preoperative CT showed high anterior column fracture of acetabulum with intact true pelvic brim, the fracture separation was less than 1 cm. All the patients were treated with closed reduction and minimally invasive percutaneous plate osteosynthesis. The quality of fracture reduction, operation time, blood loss, fracture healing time, hip function and postoperative complications were observed and recorded. All patients were followed up from 10 to 19 months with an average of 14.5 months. The quality of reduction was classified as anatomical in 4 patients, imperfect in 3, poor in 1 by Matta's score system. The operation time was 30 to 80 min, averaged 51.3 min;the blood loss was 50 to 120 ml, averaged 86.2 ml; fracture healing time was 10 to 19 weeks, averaged 13.3 weeks. At the latest follow-up, the hip function was evaluated by Merle D'Aubigne scoring system, 5 cases got excellent results, 2 cases in good, and 1 case in fair. No vascular nerve injury, wound infection, bleeding, deep vein thrombosis and other complications occurred in 8 patients. Minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim has advantages of less trauma, less bleeding, quick recovery and good curative effect, and it is a good surgical procedures for acetabulum anterior column fracture.

Association of femoral head and acetabular fractures on computerized tomography: correlation with the Judet-Letournel classification.

Tha aims of this study were to identify the incidence of femoral head fractures in the setting of acetabular fractures and to determine the relationship between acetabular fracture pattern, the degree of acetabular fracture displacement, and the incidence of femoral head fractures. This is a retrospective cross-sectional study of 274 patients with 300 acetabular fractures diagnosed on pelvic CT. Acetabular fractures were categorized using the Judet-Letournel classification system. Femoral head fractures were present in 18.0% of acetabular fractures. Fracture patterns with a posterior wall component had a very high (56.3%) incidence of femoral head fracture. Anterior column and anterior column with posterior hemitransverse fractures have a very low (3.4%) incidence of femoral head fracture. Anterior hip dislocation had a 66.7% incidence of femoral head fracture, while posterior dislocation had a 71.9% incidence. Acetabular fractures displaced by more than 5mm had a 26.9% incidence of femoral head fracture, while acetabular fracture displaced less than 5mm had only 4.2% incidence of femoral head fracture. Femoral head fractures are a very common associated finding in patients presenting with acetabular fractures. In patients with a posterior wall component of the fracture or associated hip dislocation, a femoral head fracture is more likely than not present. Conversely, in acetabular fractures with less than 5mm displacement or anterior column fractures without posterior acetabular involvement, femoral head fractures are very unlikely in the absence of a dislocation event.

The origins and current applications of classic eponymous terms for pelvic and acetabular fractures: A historic review.

We present the historical background of 5 eponymous terms in pelvic and acetabular injury treatment. The eponymous terms Duverney fracture, Malgaigne fracture, Judet-Letournel classification, Kocher-Langenbeck approach and Stoppa approach are discussed. After presenting the original description by the coining author, a short biography of the author is given. For each eponymous term the current clinical implication is given and discussed afterwards.