Fragment-specific fixation of posterior wall acetabular fractures

Purpose Fractures of the posterior wall (PW) of the acetabulum have a wide variety of patterns; treating them as a single entity using the standard ilio-ischial plate would be inappropriate. We are presenting our experience with a fragment-specific fixation technique in which each PW fragment is reduced and fixed with separate buttress/anti-glide plate(s) in a tailored fashion, abandoning the use of the ilio-ischial plate. Patients and methods Fragment-specific fixation was applied to 46 patients with PW fractures (33 simple and 13 associated fracture types) with a mean follow-up of 34.9 +/- 20.5 months (range: 12-72). Kocher-Langenbeck approach was utilized for all patients with dissection limited to the fracture site (a limited form of the approach was used in three patients). Results Anatomical reduction of the fracture was achieved in 41 (89.1%) patients, imperfect reduction in four (8.7%), and poor reduction in one (2.2%) patient. Excellent to good radiological and functional results were achieved in 91.3% of cases. A single case had recurrent subluxation which was related to avascular necrosis of the highly comminuted wall fragments. Four patients developed post-traumatic arthritis and required total hip arthroplasty. None of our cases developed clinically significant heterotopic bone formation. Conclusion With a versatile yet a strong-enough construct and limited soft tissue dissection, fragment-specific fixation yielded very good results with few complications.

Automated summary

The study demonstrated that fragment-specific fixation technique for fractures of the posterior wall of the acetabulum achieved excellent anatomical reduction and good radiological and functional results in most cases. However, recurrent subluxation and post-traumatic arthritis were observed in a small number of patients, highlighting the need for careful monitoring and management post-surgery.