Assessment of interobserver reliability and intraobserver repeatability of letournel and judet classification for acetabular fractures

Acetabular fractures account for 1–2% of all fractures and pose significant challenges for orthopedic surgeons due to complex anatomy and risks of long-term functional impairment. The Letournel and Judet (L-J) classification system, while popular for its simplicity and association with surgical outcomes, raises concerns about interobserver reliability and intraobserver repeatability across different populations. To assess the interobserver reliability and intraobserver repeatability of the L-J classification for acetabular fractures and evaluate the impact of CT scans on classification reliability. This prospective observational study was conducted at B & B Hospital, Gwarko, Lalitpur, Nepal, over one year. A total of 45 skeletally mature patients with confirmed acetabular fractures were recruited. Six experienced pelvic surgeons were divided into three groups and independently classified each fracture using the L-J system based on plain radiographs, Judet views, and CT scans. The mean age of participants was 36.75 years, with 86 % male representation. Fracture side distribution showed 46 % on the left and 54 % on the right. Interobserver reliability, assessed using Cohen's kappa coefficient, showed substantial agreement (k = 0.77) for most fracture types. Intraobserver repeatability also demonstrated substantial consistency among individual assessors over time. The evaluation of CT scans revealed insights into the reliability of the L-J classification system. This study enhances the understanding of the L-J classification's reliability for acetabular fractures, providing crucial information for its effective implementation in clinical practice.