Clin Orthop Surg.  2011 Jun;3(2):114-120. 10.4055/cios.2011.3.2.114.

Reconstruction of Acetabular Posterior Wall Fractures

• Kim HT
• Ahn JM
• Hur JO
• Lee JS
• Cheon SJ

• KMID: 1719307
• DOI: http://doi.org/10.4055/cios.2011.3.2.114

Abstract

BACKGROUND
The 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.
METHODS
Thirty-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.
RESULTS
The 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.
CONCLUSIONS
This 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.

Keyword

Acetabulum; Posterior wall fracture; Reconstruction

MeSH Terms

Acetabulum/*injuries/radiography/*surgery
Adult
Aged
Bone Plates
Bone Screws
Bone Transplantation
Female
Fracture Fixation, Intramedullary/*methods
Fractures, Bone/radiography/*surgery
Humans
Male
Middle Aged
Ossification, Heterotopic
Surgical Wound Infection
Treatment Outcome
Young Adult

Figure

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  Fig. 1 (A) Preoperative radiograph and (B) 2-dimensional and (C) 3-dimensional CT scans of a 65-year-old male with posterior wall fracture. After reduction of the osteochondral fragments with an autologous bone graft into the bone void, we performed internal fixation of the fracture with 2.4 mm lag screws and a reconstruction plate. (D) radiograph taken 3 years after surgery, the patient was free of pain with an adequate range of motion.

• 

  Fig. 2 (A) Preoperative radiograph and (B) 2-dimensional and (C) 3-dimensional CT scans of a 46-year-old male with posterior wall fracture associated with a transverse acetabular fracture. We performed reduction of the osteochondral fragments with an autologous bone graft and internal fixation of the fractures with 2.0 mm mini-screws, a spring plate and two reconstruction plates. (D) Two-dimensional and (E) 3-dimensional CT scans after surgery show congruous reduction of the posterior wall. (F) Radiograph taken 2 years after surgery, the patient showed excellent functional results.

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