• Axel Gänsslen, Jerome Tonetti, and Tim Pohlemann.
• Department of Trauma Surgery, Hannover Medical School, Hannover, Germany. dr.gaensslen@gmx.de.
• Arch Orthop Trauma Surg. 2024 Oct 1; 144 (10): 465546654655-4665.

AbstractAcetabular fractures are still challenging fractures. Fracture classification is the basis for understanding these injuries and to gain treatment and to choose a fracture type-based treatment concept. Using a systematic step-wise concept of fracture analysis, based on specific radiographic lines on standard X-rays allow even less experienced surgeons to get a correct classification of the elementary and associated fracture types of Letournel's classification. Algorithmic analysis of the iliopectineal line, (anterior column involvement), ilioischial line (posterior column involvement), presence of a posterior wall fragment, fracture lines involving the iliac wing and inferior ramus, and the spur sign (representing associated both column fractures) allow for approximately 80-90% correct classifications using standard X-rays when integrating these lines into an algorithm. Especially, T-shaped fractures, ABC and ACPHT fractures may be difficult to classify. Thus, advanced imaging, such as CT scans with multiplanar reconstruction and 3D reconstructions is additionally recommended.© 2024. The Author(s).

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