Reconstruction of Acetabular Posterior Wall Fractures

Abstract

BackgroundThe results after acetabular fracture are primarily related to the quality of the articular reduction. We evaluated the results of internal fixation of posterior wall fractures with using three-step reconstruction.MethodsThirty-three patients (mean age at the time of injury, 47.9 years; 28 males and 5 females) were followed for a minimum of 2 years after surgery. The three-step reconstruction included 1) preservation of soft tissues and reduction of the marginally impacted osteochondral (articular) fragments using screws, 2) filling the impacted cancellous void with a bone graft, and 3) reinforcement with buttress-plating. Clinical evaluation was done according to the criteria of D'aubigne and Postel, while the radiological criteria were those of Matta. The associated injuries and complications were evaluated.ResultsThe clinical results were excellent in 15 (45.5%) patients and they were good in 5 (15.2%), (i.e., satisfactory in 60.7%), while the radiologic results were excellent in 10 (30.3%) and good in 14 (42.4%) (satisfactory in 72.7%). Heterotopic ossification was common, but this did not require excision, even without prophylactic treatment with indomethacin. Deep infection was the worst complication and this was accompanied by a poor outcome.ConclusionsThis study confirms that three-step reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Therefore, we anticipate less long-term arthrosis in the patients treated this way.

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

“…However surgical approach is not fixed, the reduction is more difficult and the overall clinical results are known to be worse than simpler fracture patterns [25] [26] [27]. Displacement of the fragmented bones leads to articular incongruity of hip joint, distribution on the articular surface which leads to arthritis of joint [28]. The main goal of treatment of acetabulum fracture is to return the patient to normal functional level and to daily activities.…”

Study and results of reconstruction plating in fracture posterior column and posterior wall of acetabulum

“…2 Kim et al reported reconstruction of acetabular posterior wall fractures, in this series of 33 patient 26 had road traffic accidents, 5 had fall from height, 2 had sport related trauma. 3 In the present series out of 30 patients 28 had road traffic accidents, 2 had fall from height, the most common mode of trauma was RTA in 28 (93%). The results were found similar to previous studies.…”

“…3 Lim et al described operative treatment of acetabular fractures, in this series most of the cases 14 out of 23 involved posterior wall fractures. 5 In our present series posterior wall fractures were seen in 26 (87%) of patients and posterior column fractures were seen in 4 (13%) of cases.…”

“…3 Bassi et al described open reduction and internal fixation of posterior wall acetabular fractures. This study had 23 patients having fractures other than the fractures of acetabulum.…”

“…Open reduction and internal fixation is now the standard treatment protocol for displaced acetabulum fractures. [1][2][3][4][5][6][7][8] Open reduction and fixation is a specialised work which requires training. Most posterior acetabular fractures are comminuted or they are associated with an impaction injury of the articular surface into the underlying cancellous bone along the margin of the fracture line.…”