New CT-based classification proposed for acetabular fractures

06/01/04

A new classification for acetabular fractures using CT has been developed that is simple, unambiguous, readily understood by both radiologists and orthopedic surgeons, and provides clear direction for both diagnosis and surgical planning, says a new study by researchers from the University of Texas-Houston Medical School.

The acetabulum is the socket in the pelvis into which the thighbone fits at the hip and is often involved in injuries to the pelvis. "The pelvis is one of the most commonly injured parts of the body in high velocity or impact collisions or falls from a height. It has been reported that acetabular fractures represent approximately 29% of pelvic fractures," said John H. Harris, Jr., MD, lead author of the article.

For the study, the researchers analyzed 112 acetabular fracture patterns on CT and were able to classify the fractures into four basic categories, 0–III, with category II having four subcategories. According to Dr. Harris, CT is used to image acetabular fractures for two basic reasons, "CT images are obtained without requiring patient movement. Also, the initial cross-sectional CT images can be reformatted, without subjecting the patient to additional radiation, into images in any plane and even into 3D images very quickly. From these images, the fracture fragments and their position is unambiguously and clearly displayed," he said.

According to the study, the benefits of the new classification system extend to both orthopedic surgeons and their patients. "The type of acetabular fracture is very clearly and simply defined by the CT appearance and classification.

Therefore, the surgeon knows exactly the location and position of the principal fragments and, from this information, the type and extent of the surgical procedure required to repair the fracture can be determined even before the patient enters the operating room. Such preoperative surgical planning leads to shorter operating time and. generally, shorter recuperation time for the patient," said Dr. Harris.

The new classification system is intended to replace the Judet-Letournel classification of acetabular fractures that has been accepted worldwide since the 1960s. According to the researchers, the Judet-Letournel system has several important limitations, including awkward and repeated patient positioning, difficulties in conceptualization and wide variation in interpretation.

This study appears in the June 2004 issue of the American Journal of Roentgenology.

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