A retrospective study published in Journal of Bone and Joint Surgery identified a classification system for acetabulum fractures that the authors note provides complete classification and includes nearly all fracture patterns.
“In our work, we offer a new perspective to acetabulum fractures. We think that acetabulum fractures should be classified according to the direction in which they are displaced,” Amir Herman, MD, PhD, an investigator of the study, told Healio.com/Orthopedics. “The displacement vector can be either posterior (in a posterior wall fracture), superior-medial displacement or combined. We base a new classification for acetabulum fractures on these insights.”
Using both the novel — which integrates the displacement vector and the fractured anatomic structures — and Judet and Letournel classification systems, Herman and colleagues classified 229 patients with acetabular fractures treated between 2007 and 2016. Researchers also evaluated patients for postoperative malreduction on the basis of intra-articular gap measurements in either anteroposterior or Judet oblique views.
Results showed the novel classification system identified 60 patients in the posterior displacement vector group, 130 patients in the superomedial displacement vector group and 36 patients in the combined displacement vector group.
Researchers noted three patients remained unclassified with the novel classification system vs. 46 patients when using the Judet and Letournel classifications. Researchers described the pelvic-brim fracture patterns as along the pelvic brim, across the pelvic brim or comminuted, and described quadrilateral plate primary fracture line patterns as along the pelvic brim. According to results, the fracture type depends on the selection of surgical approach and fixation methods.
“We feel that ‘terminology is not only a communication method, but it is thought itself,’ saying that the way we describe and classify a fracture reflects the way we think about it,” Herman said. “The displacement vector as explained above should determine our surgical approach, reduction methods and fixation devices. By offering a unified approach to acetabulum fractures, we hope to provoke orthopedic trauma surgeons to rethink about these complex fractures.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.