# Judet-Letournel — Judet-Letournel classification of acetabular fractures

> Per-hemipelvis acetabular fracture classification into five elementary and five associated patterns using column, wall and transverse-component anatomy on pelvic radiographs and CT; the pattern supports approach planning but does not encode hip stability or operative indication by itself.

**Situação:** vigente · **Órgão:** Musculoesquelético · **Órgão emissor:** Judet, Judet & Letournel · **Versão:** 1964 / 1980 ten-pattern refinement · **Ano:** 1964

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR, CT
- Fonte primária: Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction (1964) — https://pubmed.ncbi.nlm.nih.gov/14239854/
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Trace the entire fracture through the columns, walls, transverse component and stable posterior ilium. Return uncertainty when attachment or extension is unresolved, and keep pattern classification separate from stability, prognosis and treatment selection.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| ant-wall | Anterior wall (elementary) | Elementary anterior-wall fracture: an independent anterior acetabular rim or wall fragment is present without complete separation of the anterior column. Confirm the wall fragment in more than one plane and account for the remaining column continuity. | The pattern identifies anterior articular exposure as the planning problem; an anterior approach is a historical option when fixation is indicated. Operative need and the exact approach still depend on displacement, congruence, dome involvement, stability and patient factors. | The label does not quantify outcome or hip stability. Prognosis depends more directly on articular displacement and reduction, marginal impaction, comminution, femoral-head injury, intra-articular fragments and age than on the wall label alone. | Alton and Gee 2014, History/Purpose and Fig. 1 list anterior wall among the five elementary patterns; Purpose and Limitations address approach planning, stability and outcome modifiers. Gansslen et al. 2024, AP wall-line and Judet-view analysis. | ✓ |
| post-wall | Posterior wall (elementary) | Elementary posterior-wall fracture: an independent posterior acetabular wall fragment is present while the posterior column remains continuous. Distinguish a true isolated wall fragment from posterior-wall involvement within an associated pattern. | A posterior exposure is the classic approach family when fixation is required, but the code alone cannot decide surgery. Report fragment size, displacement, marginal impaction, posterior hip dislocation and stability assessment because stable and unstable posterior-wall injuries occur. | Posterior-wall size, capsular integrity, comminution, hip stability and femoral-head injury influence outcome; the Letournel label supplies no individual probability. The review explicitly notes that the classification does not encode stability. | Alton and Gee 2014, Fig. 1 and Purpose identify the elementary posterior-wall pattern and posterior approach context; Limitations discusses variable wall size, capsular injury, stability, comminution and femoral-head injury. Gansslen et al. 2024, posterior-wall fragment branch. | ✓ |
| ant-column | Anterior column (elementary) | Elementary anterior-column fracture: the anterior column is separated along a variable high-to-low course that can extend from the iliac wing or pelvic brim through the acetabulum toward the obturator ring or ischiopubic segment; the iliopectineal line is disrupted. | The pattern generally directs planning toward anterior-column access when operative reduction is indicated. Preserve the fracture height and displacement because they affect exposure; do not infer an operation solely from the anterior-column label. | This is an anatomic pattern rather than a calibrated severity category. Joint congruence, dome involvement, impaction, comminution, intra-articular fragments, associated injuries and quality of reduction drive risk more than the label alone. | Alton and Gee 2014, Fig. 1, Purpose and Conclusions identify anterior column as elementary and link pattern to approach planning. Gansslen et al. 2024, iliopectineal-line, iliac-wing, inferior-ramus and CT column analysis sections. | ✓ |
| post-column | Posterior column (elementary) | Elementary posterior-column fracture: the posterior column is separated, classically along a course from the greater sciatic-notch region through the acetabulum to the obturator or ischiopubic segment; the ilioischial line is disrupted without a separate posterior-wall component. | A posterior approach family is classically used when operative fixation is selected. The report must still state displacement, joint congruence, sciatic-notch extension, wall integrity and intra-articular injury because the pattern does not itself establish operative indication. | The category does not provide a pattern-specific probability of arthritis, nerve injury or arthroplasty. Initial displacement, articular reduction, impaction, comminution, femoral-head injury, fragments and patient factors remain the major reported outcome drivers. | Alton and Gee 2014, Fig. 1 and Purpose identify posterior column as elementary and describe posterior approach context; Limitations lists prognostic modifiers. Gansslen et al. 2024, ilioischial-line and CT column-separation analysis. | ✓ |
| transverse | Transverse (elementary) | Elementary transverse fracture: one transverse component crosses both columns and separates an inferior ischiopubic segment from a superior iliac segment whose acetabular roof remains attached to the sacroiliac joint. Record the infratectal, juxtatectal or transtectal level. | Anterior, posterior or combined access may be considered depending on fracture level, direction of displacement, hip dislocation and reducibility. The code informs approach planning but does not decide treatment; weight-bearing dome involvement and congruence must be reported. | A higher transverse level can involve more of the weight-bearing dome, but no per-level probability is encoded. Long-term outcome is strongly linked to articular congruence and reduction plus impaction, comminution and joint injury rather than the word transverse alone. | Alton and Gee 2014, Fig. 1, Purpose and approach discussion identify the transverse elementary pattern and variable approach options; Limitations covers outcome modifiers. Gansslen et al. 2024, axial-CT transverse-component and algorithm sections. | ✓ |
| post-column-wall | Posterior column with posterior wall (associated) | Associated posterior-column plus posterior-wall fracture: a complete posterior-column separation coexists with an independent posterior-wall fragment. Both components must be demonstrated; a disrupted wall line alone is insufficient. | The combined posterior column and wall anatomy commonly makes posterior access relevant when fixation is indicated. Planning must additionally address wall-fragment stability, marginal impaction, column displacement, hip dislocation and femoral-head or intra-articular injury. | Associated patterns can have worse outcomes, but this label is not a numeric prognosis. Wall comminution, femoral-head injury, instability, initial displacement and final reduction quality must be reported to characterize risk. | Alton and Gee 2014, Fig. 1 lists posterior column with posterior wall among the five associated patterns; Purpose and Limitations address approach and prognostic factors. Gansslen et al. 2024, posterior-wall-fragment branch separating PC/W from isolated posterior column. | ✓ |
| transverse-wall | Transverse with posterior wall (associated) | Associated transverse plus posterior-wall fracture: a transverse component crosses both columns and an independent posterior-wall fragment is also present. Preserve the transverse roof level and the wall-fragment size, displacement and impaction. | The transverse component and posterior wall may require posterior, anterior or combined access depending on displacement and reducibility. The pattern is an approach-planning input, not an automatic indication; assess hip stability, congruence and incarcerated fragments separately. | Risk is not calibrated by this label. Posterior-wall instability or comminution, dome involvement, femoral-head injury, intra-articular fragments, delay and quality of reduction materially affect outcome. | Alton and Gee 2014, Fig. 1 and Purpose list transverse with posterior wall as associated and describe variable approaches; Limitations lists stability and outcome factors. Gansslen et al. 2024, posterior-wall branch separating TPW from pure transverse. | ✓ |
| t-shaped | T-shaped (associated) | Associated T-shaped fracture: a transverse component is joined by a distal vertical stem that separates the anterior and posterior columns below the acetabulum, typically extending into the obturator ring or ischiopubic segment. | Approach selection is variable and may require anterior, posterior or combined access according to displacement of each limb and surgeon expertise. Map both the transverse bar and inferior stem before planning; the T-shaped code alone does not mandate a procedure. | The associated topology denotes complexity but is not an ordinal risk score. Dome involvement, fragment displacement, impaction, comminution, joint contents and achievable articular reduction determine prognosis more directly. | Alton and Gee 2014, Fig. 1 and Purpose identify T-shaped as an associated pattern with variable approach options. Gansslen et al. 2024, CT analysis and Fig. 6 describe the transverse component plus distal column separation and note classification difficulty. | ✓ |
| ant-column-post-hemitransverse | Anterior column with posterior hemitransverse (associated) | Associated anterior-column plus posterior-hemitransverse fracture: a complete anterior-column component coexists with a transverse fracture limited to the posterior acetabulum, while some articular roof remains attached to the stable posterior ilium and sacroiliac joint. | Anterior-column access is commonly relevant when fixation is indicated, with additional planning for the posterior hemitransverse component. Confirm displacement and reducibility of both components; do not equate this pattern with both-column or choose an approach from the label alone. | The label does not quantify prognosis. Outcome depends on articular displacement and reduction, impaction, comminution, intra-articular fragments, femoral-head injury and patient factors; retained roof attachment distinguishes topology, not safety. | Alton and Gee 2014, Fig. 1 and Purpose list anterior column with posterior hemitransverse and anterior approach context. Gansslen et al. 2024, CT definitions distinguish ACPHT by posterior-only transverse component and retained articular attachment to the SI joint. | ✓ |
| both-column | Associated both-column (associated) | Associated both-column fracture: the anterior and posterior columns and every acetabular articular segment are disconnected from the stable posterior ilium and sacroiliac joint, producing a floating acetabulum; the spur sign supports this complete articular dissociation. | Reconstruction may require anterior, posterior or combined strategies based on the dominant displacement and accessible reduction pathway. Confirm that no articular roof remains attached to the sacroiliac joint and map all fragments; the code alone does not select surgery or approach. | Complete articular dissociation is complex, yet the label is not a patient-specific forecast. Initial displacement, marginal impaction, comminution, intra-articular fragments, femoral-head injury, age, timing and final reduction quality govern outcome. | Alton and Gee 2014, Fig. 1, Purpose and Limitations identify both-column as associated and describe approach and outcome constraints. Gansslen et al. 2024, CT analysis and algorithm define no articular fragment attached to the SI joint and the spur sign distinction from ACPHT. | ✓ |

### Citações por categoria
- **ant-wall**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, History/Purpose and Fig. 1 list anterior wall among the five elementary patterns; Purpose and Limitations address approach planning, stability and outcome modifiers. Gansslen et al. 2024, AP wall-line and Judet-view analysis.
- **post-wall**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1 and Purpose identify the elementary posterior-wall pattern and posterior approach context; Limitations discusses variable wall size, capsular injury, stability, comminution and femoral-head injury. Gansslen et al. 2024, posterior-wall fragment branch.
- **ant-column**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1, Purpose and Conclusions identify anterior column as elementary and link pattern to approach planning. Gansslen et al. 2024, iliopectineal-line, iliac-wing, inferior-ramus and CT column analysis sections.
- **post-column**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1 and Purpose identify posterior column as elementary and describe posterior approach context; Limitations lists prognostic modifiers. Gansslen et al. 2024, ilioischial-line and CT column-separation analysis.
- **transverse**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1, Purpose and approach discussion identify the transverse elementary pattern and variable approach options; Limitations covers outcome modifiers. Gansslen et al. 2024, axial-CT transverse-component and algorithm sections.
- **post-column-wall**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1 lists posterior column with posterior wall among the five associated patterns; Purpose and Limitations address approach and prognostic factors. Gansslen et al. 2024, posterior-wall-fragment branch separating PC/W from isolated posterior column.
- **transverse-wall**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1 and Purpose list transverse with posterior wall as associated and describe variable approaches; Limitations lists stability and outcome factors. Gansslen et al. 2024, posterior-wall branch separating TPW from pure transverse.
- **t-shaped**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1 and Purpose identify T-shaped as an associated pattern with variable approach options. Gansslen et al. 2024, CT analysis and Fig. 6 describe the transverse component plus distal column separation and note classification difficulty.
- **ant-column-post-hemitransverse**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1 and Purpose list anterior column with posterior hemitransverse and anterior approach context. Gansslen et al. 2024, CT definitions distinguish ACPHT by posterior-only transverse component and retained articular attachment to the SI joint.
- **both-column**: Alton TB, Gee AO. Classifications in Brief: Letournel Classification for Acetabular Fractures (2014) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3889427/ · Alton and Gee 2014, Fig. 1, Purpose and Limitations identify both-column as associated and describe approach and outcome constraints. Gansslen et al. 2024, CT analysis and algorithm define no articular fragment attached to the SI joint and the spur sign distinction from ACPHT.

## Referências cruzadas
- _fronteira compartilhada_ → [Tile — Tile classification of pelvic ring injuries](https://radcommons.laudos.ai/systems/tile-pelvis.md) — Judet-Letournel classifies acetabular fractures; Tile classifies the pelvic ring — adjacent but distinct injuries.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 1980-09-01 | revised | Letournel confirmed and refined the framework into the currently recognized five elementary and five associated patterns using a large radiographic and operative series. | confirmed |
| 1964-12-01 | published | Judet, Judet and Letournel published the radiographic column concept, acetabular fracture classification and approach-planning framework. | confirmed |


---
> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Página HTML: https://radcommons.laudos.ai/systems/letournel-acetabulum · JSON da API: https://radcommons.laudos.ai/api/v1/systems/letournel-acetabulum · Índice para agentes: https://radcommons.laudos.ai/llms.txt