In the Judet and Letournel classification of acetabular fractures, a fracture involving both the anterior column and the posterior hemitransverse element (with the characteristic spur sign on CT) is classified as:

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

Explanation

The Letournel classification has five elementary and five associated fracture patterns. The anterior column plus posterior hemitransverse (ACPHT) fracture involves: (1) the anterior column (iliopectineal line disrupted from iliac wing to pubic symphysis) AND (2) a posterior hemitransverse component that crosses the posterior acetabular wall/retroacetabular surface, without disrupting the sacroiliac joint or sciatic buttress. The spur sign (a bony spur projecting from the intact iliopectineal eminence on CT) is pathognomonic of ACPHT and both-column fractures, but in ACPHT the posterior column ilium and SI joint remain intact. In both-column fractures, all articular bone is detached from the axial skeleton.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.