An Exploratory Study To Modify The Letournel Classification Of Acetabular Fractures

The Letornel classification of acetabular fractures is the most widely used classification of acetabular fractures and the basis for orthopedic surgeons to recognize and treat acetabular fractures.The classical theory that the acetabulum is formed by two columns of bone is deeply rooted in people,s minds.However,in work and meetings author often encounters atypical acetabular fractures.These fractures are not included in the ten types of the Letournel classification.Recent studies have shown that a certain proportion of acetabular fractures cannot be classified according to the Letoumel classification.Many scholars have realized the deficiency of the Letornel classification,and some have proposed several new classifications to replace the former.At present,the Letoumel classification is still dominant.This study to explore a systematic solution to modify the Letourmel classification,was divided into four chapters.The purposes were to inherit and develop the Letournel classification,help orthopaedic surgeons understand acetabular fractures and choose treatments better.Chapter 1 The anatomical study of the acetabulum Objectives To define the territories of acetabular walls and summarize the anatomical characteristics of acetabular columns,in order to provide anatomical basis for the establishment of the modified Letournel classification.Methods According to the existing researches and the anatomical landmarks of the pelvis,the boundaries of the acetabular walls were drawn on a 3D printed pelvis model and the anatomical characteristics of the acetabular columns were analyzed.Results The acetabulum has three walls.Anterior wall,posternor wall and quadrnlateral surface have four,six and four boundaries respectively.The structure of each column of the acetabulum is a trihedron.There are three surfaces in both the anterior column and posterior column.Conclusions The territories of acetabular walls and the trihedral structure of each column are clear for the first time,which can deepen doctors' understanding of acetabular anatomy.Chapter 2 The exploratory study of the modified Letournel classification Objective To establish the modified Letournel classification.Methods A retrospective study of 170 patients(178 sides)with acetabular fractures was performed.According to the Letournel classification,with plain X-rayand plain scan and three-dimensional CT unclassifiable acetabular fractures were found out and their unclassifiable reasons were digged out and summarized.The modified Letourmel classificationu uses the following two criteria to classify the unclassifiable acetabular fractures.(l)We distinguish between wall's fracture and column's fracture using a theory that wall's fracture is two surfaces of column with interruption of continuity and column's fracture is three surfaces.(2)When column's fracture associates with wall's fracture,lowercase a,p and q are represented comminuted areas of corresponding anterior and posterior wall,quadrilateral surface respectively;when column's fracture don't associates with wall's fractire,it is marked with number 0.Results There was 51.7%(92 sides)of acetabular fractures that couldn,t be classified by the Letourmel classification.Incomplet fracture lines accounted for 53.3%(49 sides),comminuted fractures 30.4%(28 sides),both of them 16.3%(15 sides).On the grounds of the modified Letoumel classification,however,the unclassifiable percentage has dropped markedly to 0(p<0.001).Conclusions(1)All of the unclassified acetabular fractures were atypical fractures.(2)Incomplet fracture lines,comminuted fractures,both of them were their unclassifiable reasons.(3)All acetabular fractures can be classified by the modified Letournel classification.Chapter 3 The study of its roles of the modified Letournel classificaton in treatment of acetabular fracturesObjective To verify the effectiveness of the modified Letournel classification in guiding treatment.Methods Open reduction and internal fixation were performed on 112 acetabular fractures.The relationship between fracture type and surgical approach was analyzed.In this paper,anterior or posterior approach is single approach,and only when anterior approach associates with posterior one can it belong to a combined approach.Results Single and combined approach occupied 89.3%and 10.7%respectively.100%of posterior wall fracture and 80%of posternor column fracture were treated by posterior approach;100%of anterior column fracture and 73.7%of both colunns fracture were treated by anterior approach.100%(6/6)of transverse fracture(O)was managed through anterior approach and 92.9%(13/14)of transverse fracture(p)through posterior approach,which accounted for 84.4%(19/22)irn the transverse fracture;100%(6/6)of T-shaped(a)was managed through anterior approach and 100%(3/3)of T-shaped(p)through postenor approach,which accounted for 45.0%(9/20)in the T-shaped fracture.Conclusions(1)Majority of acetabular fractures can be treated by single approach.(2)The modified Letournel classification can guide the surgical approach,which is a more scientific and more mature system.Chapter 4 Progress in the treatment and research of acetabular posterior wall fracture(A review)...