Imaging Acetabular Fractures.

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Abstract

[Indexed for MEDLINE] 2. Injury. 2025 Aug;56(8):112578. doi: 10.1016/j.injury.2025.112578. Epub 2025 Jul 8. Acetabular reconstruction: From fracture pattern to fixation - part 1. Solano A(1), Serra M(2), Mereddy P(3), Godinho M(4), Le Baron M(5), Mauffrey C(6). Author information: (1)Department of Orthopedics, Fundación Santa Fe de Bogota, Bogota, Colombia; Chairman, Department of Orthopedic Surgery, Denver Health Medical Center, USA. (2)Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Chairman, Department of Orthopedic Surgery, Denver Health Medical Center, USA. (3)Senior Consultant Trauma & Orthopaedic Surgeon, Star Hospitals, Nanakramguda, Financial District, Hyderabad, Telangana, India; Chairman, Department of Orthopedic Surgery, Denver Health Medical Center, USA. (4)Unidade Local de Saúde Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Chairman, Department of Orthopedic Surgery, Denver Health Medical Center, USA. (5)Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, CHU Nord, Marseille, France; Chairman, Department of Orthopedic Surgery, Denver Health Medical Center, USA. (6)Chairman, Department of Orthopedic Surgery, Denver Health Medical Center, USA. Electronic address: mauffreyc@gmail.com. PURPOSE: Acetabular fractures remain one of the most complex injuries in orthopedic trauma surgery. Although the Judet-Letournel classification is widely accepted, it is predominantly descriptive and may offer limited intraoperative guidance. This study aims to present a simplified framework based on functional fracture orientation, distinguishing between column and transverse fracture families. Through this lens, surgical planning, reduction strategy, and fixation method selection can be facilitated. METHODS: A five-step interpretation model was developed to classify and manage acetabular fractures. The model includes: (1) identification of primary and secondary fracture lines, (2) radiographic analysis from AP and Judet views, (3) axial CT orientation to determine fracture trajectory, (4) identification of the constant fragment, and (5) evaluation of endo-pelvic and exo-pelvic accessibility. Each fracture family was analyzed to correlate fracture morphology with specific reduction maneuvers, clamp positioning, and definitive implant placement. RESULTS: Column fractures follow a coronal orientation when viewed on an axial CT, while transverse and T-type fractures propagate in a sagittal plane and often involve both columns. T-type fractures present an additional vertical component requiring dual-column reduction. For each fracture pattern, tailored reduction tools and implant configurations are proposed according to anatomical accessibility and biomechanical demands. CONCLUSION: This structured approach offers a reproducible analytical tool for preoperative planning and intraoperative execution. By simplifying fracture type interpretation and aligning morphology with fixation strategy, it supports accurate surgical decision-making, enhances training for orthopedic trauma surgeons and improves fixation outcomes. Copyright © 2025. Published by Elsevier Ltd. DOI: 10.1016/j.injury.2025.112578