Cyril Mauffrey, Nicholas Bellas, Guillaume David, Marie Le Baron
Acetabular fractures are complex injuries that demand a precise understanding of fracture morphology, radiographic interpretation, and surgical strategies. Although the Judet and Letournel classification system remains the benchmark, it poses notable challenges due to its complexity and learning curve. A narrative review was conducted synthesizing key concepts in classification, imaging interpretation, surgical planning, and fracture-specific considerations, with a focus on clinical utility. Established and novel classification systems were evaluated alongside reduction techniques and management pathways. The Judet and Letournel classification system remains clinically relevant, despite limitations in inter- and intraobserver reliability and transitional fracture classification. Surgeons benefit from reframing acetabular fractures into two major pattern families to streamline decision making. This paradigm improves recognition of displacement vectors, constant fragments, and optimal approaches. Ongoing refinement of educational tools and imaging strategies will support better outcomes. Surgical indications, including marginal impaction and geriatric management, are reviewed in detail. A simplified, concept-driven approach to acetabular fracture classification enhances clinical decision making and educational clarity. Integrating this approach with modern imaging and tailored fixation strategies offers a pathway toward improved outcomes in acetabular fracture care.