A 45-year-old man sustains a posterior hip dislocation with an associated acetabular posterior wall fracture in a dashboard injury. The Letournel classification of acetabular fractures divides them into 5 elementary and 5 associated fracture patterns. A fracture involving the anterior wall, posterior column, and the quadrilateral plate is classified as:

• A Transverse fracture
• B Both-column fracture (associated type) ✓
• C T-type fracture
• D Anterior column with posterior hemitransverse fracture

Explanation

The Letournel both-column fracture is the most common associated type (approximately 23% of all acetabular fractures) and is defined by complete dissociation of ALL articular cartilage-bearing bone from the intact axial skeleton — no piece of articular surface remains attached to the posterior column-ilium unit. It is recognized by the 'spur sign' on obturator-oblique radiograph (the posterior column spur remaining with the ilium). Involvement of the quadrilateral plate, anterior wall, and posterior column without any articular segment remaining in continuity with the ilium is characteristic of the both-column pattern.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.