Acetabular fractures revisited: part 1, redefinition of the Letournel anterior column

OBJECTIVE: The objective of part 1 of this study is to redefine the Letournel anterior column on the basis of developmental and adult pelvic skeletal anatomy. MATERIALS AND METHODS: The axial CT scans of 112 randomly selected patients with acetabular fracture or fracture-dislocations admitted to a level I trauma center between January 1998 and December 2000 were analyzed by an experienced orthopedic trauma surgeon and two experienced emergency radiologists. When available, 3D reformatted images were analyzed as well. The discrepancy between the Letournel definition of the anterior and posterior columns became readily apparent. Standard text books of anatomy and surgical anatomy were referenced relative to the embryologic and adult components of the acetabulum. RESULTS: The anterior column is redefined with its superior border being the anatomic arcuate and iliopectineal lines, thereby coinciding with the superior border (arcuate line) of the Letournel posterior column. CONCLUSION: Redefinition of the anterior column eliminates diagnostic ambiguity of the Letournel elementary anterior column fracture as well as the Letournel associated anterior column or wall with hemitransverse fracture. The redefined anterior column is integral to the CT-based classification described in part 2 of our study.