The Hip: Preservation, Replacement and Revision

Judet and Letournel Classification and Column Theory 



- Discussion:
    - classified pelvic ring injuries simply according to site of injury;
    - anterior disruption can occur thru either pubic symphysis or pubic rami;
    - injury may be through the ilium, the SI joint, or the sacrum;
    - it can involve frx-dislocation of SI joint, which commonly involves frx thru most posterior portion of iliac wing that crosses joint;
    - frx line leaves a portion of ilium in its nl position, articulating w/ upper portion of the SI joint;
    - more anterior portion of the ilium dislocates from lower SI joint;
    - acetabular fracture is another possible site of pelvic ring disruption;
    - classification: includes ten fracture types subdivided by 5 simple frx and 5 combined frx patterns;
            - 5 simple frx types: account for about 20% of acetabular frx;
                     - posterior wall;
                            - posterior wall frxs always involve posterior articular surfaces, often accompanied by a portion of retroacetabular surface and sometimes the entire surface;
                            - ilioischial line remains intact;
                     - posterior column;
                            - bony strut running from PSIS to inferior pubic ramus, & includes posterior wall;
                            - involves not only the posterior articular surfaces, but also the ilioischial line;
                     - anterior wall
                     - anterior column;
                            - bony strut running from ASIS to superior pubic ramus, & includes Anterior wall;
                            - iliopectineal line is involved;
                     - transverse frx;
                            - involve both anterior & posterior acetabulum: dividing the innominate bone into superior segment containing acetabular roof
                                    & intact ilium, & inferior segment consisting of single ischiopubic fragment;
            - 5 combined frx types:
                     - discussion:
                            - account for about 80% of acetabular frx;
                            - are composed of two or more of the elementary fracture patterns;
                            - many assoc frx types, esp two-column frx, require more extensive exposures than are achieved by either ilioinguinal or posterolateral approach alone;
                     - frx types:
                            - posterior wall & post column frx
                            - posterior wall and transverse frx
                            - t-shaped fracture
                                    - common associated frx type (about 35% of acetabular frx);
                                    - combines a transverse component & vertical component that separates the lower ischiopubic segment into the anterior and posterior columns.
                            - anterior and posterior hemitransverse frx,
                                            - anterior column or anterior wall predominating in displacement;
                                            - low and usually minimally displaced posterior hemitransverse component is present;
                            - both column frx
                                    - all segments of the articular surface are detached from the ilium;

- Radiographs: classfication is based on 3 x-ray views;
    - AP view;
    - Obturator view;
    - Iliac view



Letournel Classification for Acetabular Fractures. Assessment of Interobserver and Intraobserver Reliability.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Sunday, July 21, 2013 9:23 pm