Acetabular Fractures Revisited: Part 2, A New CT-Based Classification
John H. Harris, Jr.1,2,
Kevin J. Coupe3,
Jody S. Lee1,4 and
Thea Trotscher3
1 Department of Radiology, University of Texas-Houston Medical School, 6431
Fannin, Houston, TX 77030.
2 Present address: 200 Alta Vista Dr., Sedona, AZ 86351.
3 Department of Orthopaedic Surgery, University of Texas-Houston Medical School,
Houston, TX.
4 Present address: 2019 Red Magnolia Ct., Kingwood, TX 77339.
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Fig. 1. —Schematic representation shows mid acetabular CT scan. Line
a–a1 establishes anterior (AC) and posterior (PC) columns.
Anterior (AW) and posterior (PW) walls lie lateral to line
b–b1.
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Fig. 2A. —Type 0: wall fractures in three patients. Axial CT scan of
mid pelvis shows minimally displaced posterior wall fracture
(arrow).
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Fig. 2B. —Type 0: wall fractures in three patients. Axial CT scan shows
comminuted displaced posterior wall fracture (arrow).
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Fig. 2C. —Type 0: wall fractures in three patients. Axial CT scan shows
posterior wall fracture with fracture line at wall–column junction
(arrow).
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Fig. 3A. —Type I: single-column fracture. Axial CT scan of mid pelvis
shows minimally displaced left anterior column fracture (arrows).
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Fig. 3B. —Type I: single-column fracture. Axial CT scan of mid pelvis
shows comminuted, minimally displaced left anterior column fracture
(arrows).
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Fig. 3C. —Type I: single-column fracture. Subjacent caudal axial CT
scan shows caudal extension of comminuted anterior column fracture
(arrows).
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Fig. 3D. —Type I: single-column fracture. Further subjacent caudal
axial CT scan shows extension of anterior column fracture (white
arrow) in anterior wall (black arrow).
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Fig. 3E. —Type I: single-column fracture. Axial CT scan shows posterior
column fracture (arrow).
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Fig. 3F. —Type I: single-column fracture. Axial CT scan obtained more
caudad than E of third patient shows comminution of posterior column
fracture (arrows).
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Fig. 4A. —Type IIA: two-column fracture without extension but with
associated posterior wall fracture. Supraacetabular axial CT scan shows
anterior column fracture (white arrow), iliopectineal line
(arrowhead), and posterior column fracture (solid black
arrow). Open arrow indicates superiorly displaced posterior wall
fragment.
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Fig. 4B. —Type IIA: two-column fracture without extension but with
associated posterior wall fracture. Axial CT scan obtained more caudad than
A of same patient shows anterior (white arrow) and posterior
(solid black arrow) column fractures. Open arrows indicate associated
posterior wall fracture.
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Fig. 5A. —Type IIB: two-column fracture with superior extension to
iliac wing. Three-dimensional reformatted CT scan shows anterior (white
arrows) and posterior (curved arrow) column fractures. Arrowhead
indicates iliopectineal line. Straight black arrow indicates superior
extension of acetabular fracture to iliac wing.
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Fig. 5B. —Type IIB: two-column fracture with superior extension to
iliac wing. Axial CT scan of false pelvis shows superior extension of fracture
(arrow) above iliopectineal line (arrowhead) into iliac
wing.
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Fig. 5C. —Type IIB: two-column fracture with superior extension to
iliac wing. Axial CT scan of false pelvis shows fracture (arrow) at
level of iliopectineal line.
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Fig. 5D. —Type IIB: two-column fracture with superior extension to
iliac wing. Axial CT scan shows comminuted anterior column fracture with
associated anterior wall component (white arrows) and posterior
column fracture (black arrow).
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Fig. 6A. —Type IIC: two-column acetabular fracture with inferior
extension. Axial CT scan of false pelvis shows each iliac wing intact thereby
excluding superior fracture extension.
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Fig. 6B. —Type IIC: two-column acetabular fracture with inferior
extension. Axial CT scan shows comminuted and displaced anterior (white
arrow) and posterior (black arrow) column fractures.
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Fig. 6C. —Type IIC: two-column acetabular fracture with inferior
extension. Axial CT scan through level of pelvic outlet shows fracture
(arrow) of left ischial tuberosity.
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Fig. 7A. —Type IID: two-column acetabular fracture with superior and
inferior extension. Three-dimensional reformatted CT scan shows anterior
(white arrows) and posterior (long black arrow) column
fractures, superior extension above iliopectineal line (short black
arrow), and inferior extension (arrowhead).
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Fig. 7B. —Type IID: two-column acetabular fracture with superior and
inferior extension. Mid pelvic axial CT scan shows left anterior (white
arrow) and posterior (black arrow) column fractures.
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Fig. 7C. —Type IID: two-column acetabular fracture with superior and
inferior extension. Axial CT scan obtained rostral to iliopectineal line
(arrowhead) shows superior fracture extension to iliac wing
(arrow).
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Fig. 7D. —Type IID: two-column acetabular fracture with superior and
inferior extension. Axial CT scan obtained through inferior pubic rami shows
inferior fracture extension to left inferior pubic ramus
(arrows).
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Fig. 8A. —Type III: floating acetabulum. Three-dimensional reformatted
CT scan shows anterior (long white arrows) and inferior pubic ramus
fractures (short white arrow) which, together, separate acetabulum
from axial skeleton anteriorly; posterior column fracture (long black
arrow), which separates acetabulum from axial skeleton posteriorly;
superior fracture extension to right iliac wing (arrowhead); and
inferior fracture extension (short black arrow).
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Fig. 8B. —Type III: floating acetabulum. Axial CT scan obtained through
level of iliopectineal line shows right superior fracture extension
(arrow).
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Fig. 8C. —Type III: floating acetabulum. Axial CT scan shows comminuted
displaced right posterior column fracture (arrows). Arrowhead
indicates iliopectineal line.
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Fig. 8D. —Type III: floating acetabulum. Mid pelvic axial CT scan shows
comminuted, displaced anterior column fracture (arrows).
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Fig. 8E. —Type III: floating acetabulum. Axial CT scan obtained through
level of inferior pubic rami shows comminuted, displaced fracture of right
inferior pubic ramus (arrow).
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Fig. 9. —Diagram shows relationship of Letournel fracture types to
Harris-Coupe categories.
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Copyright © 2004 by the American Roentgen Ray Society.
