Acetabular Fractures — Letournel

Acetabular fractures are serious injuries involving the articular socket of the hip joint. These fractures usually occur following high-energy trauma such as road traffic accidents or falls from height. In elderly individuals with osteoporotic bone, acetabular fractures may occur after low-energy mechanisms such as simple falls.

The acetabulum is a complex three-dimensional structure that forms the socket for the femoral head. Accurate reduction of the articular surface is critical for restoring hip joint congruity and preventing post-traumatic arthritis. Because of this complexity, acetabular fractures require careful classification, detailed imaging, and often surgical management.

The most widely used classification system for acetabular fractures was developed by Letournel and Judet. This system categorizes fractures based on the involvement of the anterior and posterior columns of the acetabulum.

The acetabulum is formed by the fusion of three bones: the ilium, ischium, and pubis. These bones converge to form a deep socket that articulates with the femoral head to form the hip joint.

• Anterior column – formed by pubis and anterior ilium
• Posterior column – formed by ischium
• Acetabular dome – weight-bearing portion
• Acetabular fossa – central non-articular area

The acetabulum can be conceptualized as an inverted Y structure consisting of anterior and posterior columns. Disruption of these columns determines the pattern and stability of acetabular fractures.

Most acetabular fractures occur due to high-energy trauma that transmits force from the femoral head into the acetabulum.

• Road traffic accidents (dashboard injuries)
• Fall from height
• Crush injuries
• Low-energy falls in elderly osteoporotic patients

The classic mechanism is a dashboard injury in which the flexed knee strikes the dashboard during a collision, transmitting force along the femur to the acetabulum.

The Letournel classification divides acetabular fractures into five elementary patterns and five associated patterns.

• Severe hip pain
• Inability to bear weight
• Shortened or internally rotated limb
• Associated hip dislocation
• Bruising around pelvis

Associated injuries are common due to the high-energy nature of trauma. These may include pelvic fractures, abdominal injuries, and head trauma.

• Pelvic X-ray (AP view)
• Judet views (obturator and iliac oblique views)
• CT scan with 3D reconstruction

CT scanning is essential for evaluating fracture displacement, intra-articular fragments, and planning surgical treatment.

• Displacement greater than 2 mm
• Incongruent hip joint
• Intra-articular fragments
• Unstable hip joint
• Associated hip dislocation

• Post-traumatic arthritis
• Avascular necrosis of femoral head
• Heterotopic ossification
• Sciatic nerve injury
• Deep infection

• Letournel classification is most widely used
• Dashboard injury is the classic mechanism
• CT scan is essential for surgical planning
• Goal of treatment is anatomical reduction