The posterior wall fracture -the most frequent acetabular lesion -is often regarded as the simplest acetabular fracture. In fact, a large variety of complex articular lesions is subsumed under this fracture type.A consecutive series of 60 posterior wall fractures is reviewed retrospectively. Lesion characteristics, treatment method, early and late postoperative complications and 2-year functional results were recorded.In 27 patients (45%), additional damage to the cartilage of the acetabular cavity such as subchondral impaction, free articular fragments or separation of the posterior wall into several pieces was present. Seven patients (11.6%) showed preoperative neurologic deficit. Secondary nerve damage was present in 8.3%. Early secondary surgery was necessary in 8.3%. During the first 2 years, additional surgery was performed in 7/46 patients (15.2%). The rate of periarticular ossifications amounted to 26.1%. The rate of excellent and good results was 69.5%.Posterior wall fracture of the acetabulum is a more complex injury than generally accepted. The trauma surgeon's task is to completely identify the lesion and to consider all aspects of the injury during surgery and rehabilitation. Even in experienced hands, excellent and good long-term results will not exceed 75%. Poor results are due to the difficulty of posterior wall reconstruction, partial osteonecrosis and/or complications caused by the Kocher-Langenbeck approach.

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In this case report, a 56 year old patient with tuberculous destruction of the right sacroiliac joint is presented. Diagnosis was delayed because of unspecific signs of lumbalgia, which were interpreted as the consequence of nerve root compression. There was a specific infiltration into the surrounding intra- and extrapelvic muscles. Therapy is surgical, followed by a combination drug therapy for at least one year.

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