T-type acetabular fracture with posterior wall fracture, letournel classification defied: Case report

Abstract

More than 50 years ago Letournel and Judet, came up with a classification for acetabular fractures that remain the gold standard and means of communication between surgeons. A 71 years old man, presented after being involved in road traffic accident. Judet and pelvic CT-scans showed complex acetabular fracture characterized by free fragments of posterior wall, posterior column, anterior column fractures with an associated acetabula protrusio and obturator foramen fracture. Computed Topography(CT) of the chest showed pleural effusion from which he recovered five days later. Kocher-Langenbeck incision was used to access the fractures. Acetabular comminution noted. Reduction and fixation obtained with the help of two 3.5mm reconstruction plates and screws. Closure done in standard fashion. Follow-up was done in week 4 and 8. Letournel divides acetabular fractures into five elementary and five associated types. Surgical planning i.e Surgery timing, patient positioning, surgical approach, type of implants and reduction tools are largely determined by accurate diagnosis. Technical expertise on the part of the surgeon and the team is also of utmost importance in order to obtain favorable results. Such unique fractures may be undiagnosed due to lack of thorough description under the present Letournel system. In view of the fact that this classification is usually used in the surgical planning for approaches, such lack of thorough description and classification impacts on optimal fixation of complex acetabular fractures. This therefore, probably calls for a re-look of acetabular fracture classification and more reporting by surgeons.

Key words: Acetabular, T-Type, Posterior wall, Letournel classification, Fracture