https://doi.org/10.53453/ms.2026.6.5
Acetabular fractures: mechanism, classification, management and
complications
Ugnius Chmieliauskis
1
, Goda Monstavičiūtė
1
, Alfredas Smailys
2
1
Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine, Kaunas, Lithuania
2
Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine, Department of Orthopaedics
and Traumatology, Kaunas, Lithuania
Abstract
Introduction. Acetabular fractures (AFs) are complex intra-articular injuries that require accurate assessment of
fracture morphology and individualized treatment planning. Their incidence is increasing, particularly in older
populations. Even small incongruities can lead to poor outcomes, making precise management essential.
Aim: to summarize the existing literature on mechanism of injury, classification systems, management techniques
and complications of acetabular fractures.
Material and methods: a narrative literature review was conducted using PubMed, Google Scholar and
ScienceDirect databases. Articles written in English and published in 2021–2026 were included.
Results. Understanding the mechanisms of injury and applying standardized classification systems, such as the
Judet-Letournel and AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen /Orthopaedic Trauma Association)
classifications, are essential for choosing appropriate management strategies. While non-operative treatment may
be suitable for minimally displaced fractures, most displaced injuries require anatomical reduction and stable
fixation using open reduction, internal fixation (ORIF), whereas total hip arthroplasty (THA) may be considered
in selected cases, particularly in elderly patients with osteoporotic bone or highly comminuted fractures. Despite
advances in diagnostic imaging and surgical techniques, AFs remain associated with a substantial risk of
complications, including post-traumatic osteoarthritis, neurovascular injury, heterotopic ossification, and the
potential need for secondary THA. Therefore, careful patient selection, appropriate surgical approach, and long-
term follow-up are critical to optimize functional outcomes.
Conclusions. AFs are complex injuries that demand precise evaluation and tailored management. Anatomical
reduction is key for favorable outcomes, although complications remain frequent, highlighting the importance of
appropriate surgical strategy and follow-up.
Keywords: acetabular fracture, classification, mechanism of injury, management, complications.
Journal of Medical Sciences. 18 Jun, 2026 - Volume 14 | Issue 4. Electronic - ISSN: 2345-0592
Medical Sciences 2026 Vol. 14 (4), p. 48-55, https://doi.org/10.53453/ms.2026.6.5
48
Gūžduobės lūžiai: mechanizmas, klasifikacija, gydymas ir
komplikacijos
Ugnius Chmieliauskis
1
, Goda Monstavičiūtė
1
, Alfredas Smailys
2
1
Lietuvos sveikatos mokslų universitetas, Medicinos akademija, Medicinos fakultetas, Kaunas, Lietuva
2
Lietuvos sveikatos mokslų universitetas, Medicinos akademija, Medicinos fakultetas, Ortopedijos ir
traumatologijos klinika, Kaunas, Lietuva
Santrauka
Įvadas. Gūžduobės lūžiai yra sudėtingi intrasąnariniai sužalojimai, reikalaujantys tikslaus lūžio morfologijos
įvertinimo ir individualaus gydymo planavimo. Jų dažnis didėja senstančioje populiacijoje. Net nedidelis sąnarinio
paviršiaus kongruentiškumo praradimas sąlygoja prastas išeitis, todėl ypatingai svarbus tikslus gydymas.
Tikslas: apibendrinti esamą literatūrą aprašančią gūžduobės lūžius ir jų traumos mechanizmą, klasifikacijos
sistemas, gydymo galimybes ir komplikacijas.
Tyrimo medžiaga ir metodai: atlikta aprašomoji literatūros apžvalga. Publikacijų paieška atlikta naudojant
PubMed, Google Scholar ir ScienceDirect duomenų bazes. Įtraukti anglų kalba rašyti straipsniai, publikuoti 2021–
2026 m.
Rezultatai. Siekiant parinkti tinkamą gydymą, būtina išsiaiškinti traumos mechanizmą ir taikyti standartizuotas
klasifikavimo sistemas, tokias kaip Judet-Letournel ir AO/OTA (Arbeitsgemeinschaft für
Osteosynthesefragen/Ortopedų traumatologų asociacija). Neoperacinis gydymas gali būti taikomas kai kuriems
lūžiams su minimalia dislokacija. Daugumai dislokuotų lūžių būtina anatominė repozicija ir stabili fiksacija
panaudojant atvirą repoziciją ir vidinę fiksaciją. Pasirinktinais atvejais, ypač vyresnio amžiaus pacientams,
sergantiems osteoporoze arba esant skeveldriniams lūžiams, gali būti svarstoma pirminė klubo sąnario
endoprotezavimo operacija. Nepaisant diagnostinių ir chirurginių metodų pažangos, gūžduobės lūžiai vis dar
pasižymi nemaža potrauminės artrozės, neurovaskulinių pažeidimų, heterotopinės osifikacijos komplikacijų rizika
ir padidėjusiu antrinės klubo sąnario endoprotezavimo operacijos poreikiu. Taigi, kruopšti pacientų atranka,
tinkama chirurginė technika ir ilgalaikė stebėsena yra būtini, siekiant geriausių funkcinių rezultatų.
Išvados. Gūžduobės lūžiai yra sudėtingi sužalojimai, reikalaujantys tikslaus ištyrimo ir individualizuoto gydymo.
Anatominė repozicija yra pagrindinis veiksnys, lemiantis geras klinikines išeitis. Dėl dažnai pasireiškiančių
komplikacijų išryškėja chirurginio gydymo pasirinkimo ir tolimesnės priežiūros svarba.
Raktažodžiai: gūžduobės lūžiai, klasifikacija, traumos mechanizmas, gydymas, komplikacijos.
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1. Introduction
Acetabular fractures are complex intra-articular
injuries that disrupt the structural integrity of the
pelvis and alter the distribution of mechanical forces
between the axial skeleton and the lower limbs [1].
Given their intra-articular nature, even minor joint
incongruity can lead to devastating long-term
outcomes, including hip instability and rapidly
progressing post-traumatic osteoarthritis [1,2].
Although relatively uncommon, the incidence of
AFs has been increasing in recent years, particularly
in aging populations [1,3,4]. Epidemiological data
from the Netherlands, a Western European country,
demonstrated that the overall incidence nearly
doubled from 4.03 to 8.23 cases per 100.000
individuals between 2012 and 2022 [5]. The
mechanism of injury typically follows a bimodal
distribution: in young adults, high-energy trauma,
such as motor vehicle accidents, remains the primary
cause, often resulting from forces transmitted
through the femoral head [1,6]. Conversely, in the
aging population, these fractures are increasingly
observed after low-energy falls, where osteoporotic
bone failure becomes the defining factor [3,4,6].
Accurate evaluation of fracture morphology using
radiography and computed tomography (CT) is
essential for appropriate diagnosis and treatment
planning [1,2,7]. AFs are primarily categorized
using the Judet-Letournel classification, which
remains the clinical gold standard, while the
AO/OTA (AO Foundation (Arbeitsgemeinschaft für
Osteosynthesefragen) and the Orthopaedic Trauma
Association) system serves as its standardised
equivalent [1,3,7–9]. Treatment strategies depend on
individual patient characteristics, fracture pattern,
displacement and hip joint stability [1]. While stable,
minimally displaced fractures may be managed
conservatively, displaced injuries usually require
ORIF [1–3,6]. The primary goal of surgery is to
restore the anatomical alignment of the acetabulum
and prevent long-term joint degeneration [1,2,6].
This narrative review aims to synthesize current
knowledge on injury mechanisms, classification
systems, management strategies and complications
of AFs.
2. Material and methods
A narrative literature review was conducted.
Literature regarding acetabular fractures was
identified using PubMed, Google Scholar and
ScienceDirect databases. Articles were searched
using English keywords and their combinations:
acetabular fractures, mechanism of injury,
classification, surgical management, ORIF and
complications. English, full-text articles published
within the last five years were reviewed and
summarized.
3. Results
3.1. Mechanism of injury
AFs result from the transmission of traumatic forces
through the femur, causing the femoral head to
impact the acetabular articular surface [1,4].
Fracture patterns are determined by the magnitude
of the force and orientation of the hip joint at the
time of injury. Rotational alignment of the femur is
a key determinant in directing the force vector.
External rotation of the hip tends to direct the
femoral head anteriorly and is therefore associated
with anterior column or anterior wall fracture
patterns. When the hip is internally rotated, the force
is shifted posteriorly and is commonly associated
with posterior wall or posterior column fractures [1].
Direction of the applied traumatic force further
influences fracture morphology. High-energy
mechanisms, such as motor vehicle collisions, often
occur with the hip in flexion and may result in axial
force transmission through the femoral shaft,
resulting in the classic “dashboard injury” and
posterior AFs. Conversely, lateral impacts, such as
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50
falls onto the greater trochanter, direct forces
medially towards the acetabulum. In elderly patients
with osteoporotic bone, this mechanism frequently
results in anterior column or medial wall fractures
even after low-energy trauma [1,4].
3.2. Acetabular fracture classification
The classification of AFs evolved alongside the
development of their surgical management. Prior to
the 1960s, these injuries were commonly treated
conservatively and were broadly categorized
according to their association with posterior or
central hip dislocations [9]. However, unsatisfactory
outcomes following non-operative treatment
prompted Judet and Letournel to explore surgical
management using ORIF [9]. Through correlation of
radiographic findings with intraoperative
observations, they developed a systematic
classification of AF patterns, which was later refined
and remains the foundation of modern AF
classification [7,10].
The Judet-Letournel classification is based on the
anatomical concept of the acetabular columns and
walls. According to this system, fractures are
divided into elementary and associated patterns
depending on whether a single or multiple
acetabular structures are involved. Overall, five
elementary fracture types (posterior wall, posterior
column, anterior wall, anterior column, and
transverse) and five associated fracture types
(posterior column with posterior wall, transverse
with posterior wall, T-shaped, anterior column with
posterior hemitransverse, and both-column
fractures) are described [1].
In addition, the AO/OTA classification system,
which is derived from the Judet–Letournel
framework, has been developed to provide a
standardized method for fracture description and to
facilitate communication between clinicians and
researchers. In this system, AFs are defined by three
main fracture types (A, B, and C), subdivision of
three groups and three subgroups (1, 2 and 3) based
on fracture location and complexity [11]. Type A
fractures are partial articular and involve a single
wall or column, type B fractures represent partial
articular injuries with transverse fracture
components, whereas type C fractures involve both
acetabular columns and complete dissociation of the
articular surface from the axial skeleton.
Understanding fracture morphology according to
these classification systems is essential for treatment
planning, as the fracture pattern largely determines
the optimal surgical approach and management
strategy [7,12].
3.3. Acetabular fracture management
Management of AFs is initiated by the
multidisciplinary team that is guided by Advanced
Trauma Life Support (ATLS) protocols, which
prioritize life-saving interventions to ensure
hemodynamic and other vital functions before
addressing the fracture [1,2]. Once the patient is
stabilized, fracture assessment is performed using
standard radiographic evaluation, including
anteroposterior pelvic and 45° oblique Judet views,
while CT scan is used to further define fracture
morphology and articular involvement, guiding
subsequent treatment planning [1,2,8].
Non-operative management may be appropriate
when fracture displacement is minimal (<2 mm) and
in situations when a patient is not a suitable
candidate for surgery [4]. Conservative treatment
typically includes adequate analgesia, protected
weight-bearing or skeletal traction for
approximately 6-12 weeks, and functional
rehabilitation [1]. Close clinical and radiographic
follow-up is required to ensure that secondary
displacement does not occur during the healing
process [10].
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Surgical treatment is indicated when displace-ment
of the articular surface compromises joint congruity
or when the fracture results in instability of the hip
joint, with ORIF remaining the standard operative
treatment for most displaced AFs. The primary
objective of surgery is anatomical reduction of the
acetabular articular surface and stable fixation of the
fracture fragments, thereby restoring normal hip
biomechanics and reducing the risk of post-
traumatic joint degeneration [2,14].
In elderly patients with osteoporotic bone or highly
comminuted fracture patterns, reconstructive
fixation may be challenging and associated with
unfavorable outcomes. In such cases, total hip
arthroplasty, either alone or in combination with
ORIF, may be considered as an alternative treatment
strategy [4]. Therefore, treatment decisions should
be individualized, taking into account fracture
morphology, bone quality, and the patient’s
functional status [3].
3.4. Surgical approaches
Due to the variability in fracture morphology and
anatomical involvement, no single surgical approach
is applicable to all AFs [9]. Surgical exposure is
therefore selected according to the fracture pattern,
the location and magnitude of displacement, and the
time elapsed since injury [1]. In general, AFs
surgical approaches are divided into posterior and
anterior approaches.
The Kocher-Langenbeck approach is the main
posterior approach and is typically used for fractures
involving the posterior column or posterior wall
[4,9,10].
Anterior fracture patterns are traditionally managed
using the ilioinguinal approach, which provides
exposure of the anterior column and pelvic brim
through three anatomical windows [9]. However, in
recent years the modified Stoppa approach has
increasingly replaced the ilioinguinal approach in
many cases, as it allows improved visualization of
the quadrilateral surface and medial acetabular
structures with less soft-tissue dissection and
reduced intraoperative blood loss [4,8,13].
For complex fracture patterns involving both
columns or in delayed surgical treatment, extensile
approaches such as the extended iliofemoral
approach may be used, as they allow broad exposure
of the acetabulum [9]. In selected cases, combined
anterior and posterior approaches may also be
required to achieve adequate visualization,
anatomical reduction, and stable fixation [10].
3.5. Complications of acetabular fractures
Despite diagnostic and management advancements
of AFs, complications can arise from the initial
trauma or the treatment itself.
Injury-related complications are primarily
associated with damage to the articular surface and
surrounding structures at the time of trauma [14].
One of the most significant long-term consequences
is post-traumatic osteoarthritis which has been
reported to occur in approximately 13-44% of
patients following AFs and is often related to
residual joint incongruity or cartilage injury [15].
Neurovascular structures may also be affected, most
commonly the sciatic nerve, particularly in fracture
patterns involving the posterior acetabulum or
associated hip dislocation. A meta-analysis has
reported that sciatic nerve injury occurs in
approximately 10-30% of AFs, reflecting the close
anatomical relationship between the nerve and the
posterior aspect of the joint [16].
Thromboembolic events represent another
recognized complication following pelvic and
acetabular trauma. Clinical series have reported
deep venous thrombosis (DVT) in approxima-tely 3-
4% of patients, whereas pulmonary embolism (PE)
occurs less frequently [17]. Other studies suggest
that venous thromboembolism may develop in up to
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52
one in ten patients with pelvic or acetabular fractures
[18].
Complications may also occur following fracture
management, particularly after ORIF [2]. Surgical
site infections have been reported in approximately
4-11% of cases, reflecting the invasive nature and
technical complexity of AF surgery [1,19].
Identified risk factors include higher body mass
index, greater fracture severity, prolonged operative
time, and increased intraoperative blood loss.
Neurological complications may also occur
following surgical treatment [2]. Iatrogenic nerve
injury has been reported in approximately 6.5% of
patients, with the specific nerve affected depending
on the fracture pattern and surgical approach [19].
The lateral femoral cutaneous nerve is most
frequently involved, followed by the sciatic and
obturator nerves. In particular, postoperative sciatic
nerve palsy has been reported in 5-15% of cases,
most commonly in association with posterior
surgical approaches [16].
Another well-recognized postoperative compli-
cation is heterotopic ossification (HO), which may
impair hip mobility and functional recovery [9]. The
reported incidence of HO after AF surgery ranges
between 19% and 25% [19].
Even after technically successful fixation,
degenerative changes of the hip joint may develop
over time. As a result, approximately 20–40% of
patients may ultimately require conversion to THA
due to progressive post-traumatic osteoarthritis [14].
Conversion to THA following previous AF fixation
can be technically demanding because of altered
anatomy, retained implants, scar tissue formation,
and potential bone defects, and is therefore
associated with higher complication rates compared
with primary THA performed for degenerative joint
disease [15].
Finally, patient-related factors may influence the risk
of treatment failure and the likelihood of requiring
secondary procedures. Advanced age, secondary
diseases, osteoporotic bone, and fracture
comminution may compromise fixation stability and
increase the probability of subsequent joint
degeneration, particularly in elderly patients [4].
4. Conclusion
AFs are complex intra-articular injuries that require
accurate assessment of fracture morphology and
individualized treatment planning. Understanding
the mechanisms of injury and applying standardized
classification systems are essential for guiding
appropriate management strategies. While non-
operative treatment may be suitable for selected
minimally displaced fractures, most displaced
injuries require anatomical reduction and stable
fixation using ORIF, whereas THA may be
considered in selected cases, particularly in elderly
patients with osteoporotic bone or highly
comminuted fractures. Despite advances in
diagnostic imaging and surgical techniques, AFs
remain associated with a substantial risk of
complications, including post-traumatic osteo-
arthritis, neurovascular injury, heterotopic
ossification, and the potential need for secondary
THA. Therefore, careful patient selection,
appropriate surgical approach, and long-term
follow-up are critical to optimize functional
outcomes.
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