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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

- Quadrilateral Plante Fractures:
The “safe zone” for infrapectineal plate-screw fixation of quadrilateral plate fractures: An anatomical study and retrospective clinical evaluation

A Sobering Message to Acetabular Fracture Surgeons: Commentary on an article by Diederik O. Verbeek, MD, et al.: "Predictors for Long-Term Hip Survivorship Following Acetabular Fracture Surgery. Importance of Gap Compared with Step Displacement".

Predictors for Long-Term Hip Survivorship Following Acetabular Fracture Surgery: Importance of Gap Compared with Step Displacement.

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