International Orthopaedics

, Volume 42, Issue 8, pp 1957–1965 | Cite as

Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification

  • Amer Sebaaly
  • Guillaume Riouallon
  • Mourad Zaraa
  • Peter Upex
  • Véronique Marteau
  • Pomme Jouffroy
Original Paper



Evaluate the role of four standardized 3D reconstruction views in the accurate diagnosis of acetabular fractures.

Materials and methods

Thirty-five acetabular fracture cases were selected from a tertiary centre database. Fourteen reviewers with different experience level evaluated this set of images which were provided in axial 2D views and multiplanar reconstruction (MPR) without 3D views in the first two readings then the standardized 3D views were added for the subsequent two readings. The primary outcome was the accuracy of diagnosis while inter-observer reliability and reading time as well as time needed for accurate diagnosis were evaluated.


Accuracy of classification was 56.7% using the 2D and 73% using the described 3D (p < 0.001). Improvement was noted in all groups even though the expert group showed the least improvement (6.7% (p = 0.04)) and the least experience group showed the most improvement (35.7% (p < 0.001)). Average time of interpretation was 96 minutes for the 2D sets and 47 minutes for the 3D sets. Finally, the adding of the four standardized views increased the inter-observer reliability in all groups compared to the standard 2D sets with MPR.


Acetabular fracture diagnosis according to Letournel classification is difficult and depends greatly on the experience of the reader. The described set of 3D images yields better accuracy and renders the diagnosis more repeatable and faster. We recommend the use of these images in classifying acetabular fractures.


Acetabular fractures 3D reconstructions Letournel classification CT scanner 


Compliance with ethical standards

Our institutional review board approved this study and patient informed consent was not required

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Scheinfeld MH, Dym AA, Spektor M et al (2015) Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics 35:555–577. CrossRefPubMedGoogle Scholar
  2. 2.
    Alton TB, Gee AO (2014) Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res 472:35–38. CrossRefPubMedGoogle Scholar
  3. 3.
    Beaulé PE, Dorey FJ, Matta JM (2003) Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability. J Bone Joint Surg Am 85–A:1704–1709CrossRefPubMedGoogle Scholar
  4. 4.
    Hüfner T, Pohlemann T, Gänsslen A et al (1999) The value of CT in classification and decision making in acetabulum fractures. A systematic analysis. Unfallchirurg 102:124–131CrossRefPubMedGoogle Scholar
  5. 5.
    Letournel E, JUDET R (1993) Fractures of the acetabulum, 2nd editio. Springer, New YorkCrossRefGoogle Scholar
  6. 6.
    Sinatra PM, Moed BR (2014) CT-generated radiographs in obese patients with acetabular fractures: can they be used in lieu of plain radiographs? Clin Orthop Relat Res 472:3362–3369. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Clarke-Jenssen J, Øvre SA, Røise O, Madsen JE (2015) Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous? Arch Orthop Trauma Surg 135:913–918. CrossRefPubMedGoogle Scholar
  8. 8.
    Hutt JRB, Ortega-Briones A, Daurka JS et al (2015) The ongoing relevance of acetabular fracture classification. Bone Joint J 97–B:1139–1143. CrossRefPubMedGoogle Scholar
  9. 9.
    Visutipol B, Chobtangsin P, Ketmalasiri B et al (2000) Evaluation of Letournel and Judet classification of acetabular fracture with plain radiographs and three-dimensional computerized tomographic scan. J Orthop Surg (Hong Kong) 8:33–37CrossRefGoogle Scholar
  10. 10.
    Garrett J, Halvorson J, Carroll E, Webb LX (2012) Value of 3-D CT in classifying acetabular fractures during orthopedic residency training. Orthopedics 35:e615–e620. CrossRefPubMedGoogle Scholar
  11. 11.
    Ohashi K, El-Khoury GY, Abu-Zahra KW, Berbaum KS (2006) Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary? Radiology 241:386–391. CrossRefPubMedGoogle Scholar
  12. 12.
    Kickuth R, Laufer U, Hartung G et al (2002) 3D CT versus axial helical CT versus conventional tomography in the classification of acetabular fractures: a ROC analysis. Clin Radiol 57:140–145. CrossRefPubMedGoogle Scholar
  13. 13.
    Polesello GC, Nunes MA, Azuaga TL et al (2012) Comprehension and reproducibility of the Judet and Letournel classification. Acta Ortop Bras 20:70–74. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    O’Toole RV, Cox G, Shanmuganathan K et al (2010) Evaluation of computed tomography for determining the diagnosis of acetabular fractures. J Orthop Trauma 24:284–290. CrossRefPubMedGoogle Scholar
  15. 15.
    Schäffler A, Fensky F, Knöschke D et al (2013) CT-basierten Klassifikationshilfe für Acetabulumfrakturen. Unfallchirurg 116:1006–1014. CrossRefPubMedGoogle Scholar
  16. 16.
    Matta JM (2006) Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. J Orthop Trauma 20:S20–S29PubMedGoogle Scholar
  17. 17.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  18. 18.
    Schatzker J (2003) The rationale of operative fracture care, 3rd editio. Springer, AtlantaGoogle Scholar
  19. 19.
    Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report J Bone Joint Surg Am 46:1615–1646CrossRefPubMedGoogle Scholar
  20. 20.
    Potok PS, Hopper KD, Umlauf MJ (1995) Fractures of the acetabulum: imaging, classification, and understanding. Radiographics 15:7–23–4. CrossRefPubMedGoogle Scholar
  21. 21.
    Jouffroy P, Sebaaly A, Aubert T, Riouallon G (2016) Improved acetabular fracture diagnosis after training in a CT-based method. Orthop Traumatol Surg Res.
  22. 22.
    Wu H, Luo J, Zhu Z (2000) Clinical study of three-dimensional reconstruction of computed tomography in diagnosis of condylar fractures. Hua Xi Kou Qiang Yi Xue Za Zhi 18:42–44PubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryGroupe Hospitalier Paris Saint JosephParisFrance
  2. 2.School of MedicineSaint Joseph UniversityBeirutLebanon
  3. 3.Department of Diagnostic RadiologyGroupe Hospitalier Paris Saint JosephParisFrance

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