J Korean Fract Soc.  2007 Apr;20(2):123-128. 10.12671/jkfs.2007.20.2.123.

Surgical Treatment of Posterior Wall Fractures of the Acetabulum

• Byun YS
• Chang SA
• Cho YH
• Hwang DH
• Lee SR
• Kim SH

• KMID: 2295568
• DOI: http://doi.org/10.12671/jkfs.2007.20.2.123

Abstract

PURPOSE
To evaluate the results of surgical treatment of posterior wall fractures of the acetabulum and to determine the factors affecting the results.
MATERIALS AND METHODS
Thirty-one posterior wall fractures were reviewed; 7 type A1-1, 19 type A1-2 and 5 type A1-3 by AO classification. Postoperatively, the accuracy of the reduction was evaluated. At the final follow-up, clinical and radiographic results were evaluated with medical records and radiographs. The factors affecting the results were determined.
RESULTS
The reduction was graded as anatomical in 22 patients, imperfect in seven and poor in two. The clinical result was excellent in 21 hips, good in six, fair in three and poor in one. The quality of the reduction was strongly associated with the clinical result. The radiographic result was excellent in 22 hips, good in five, fair in two and poor in two. The clinical result was related closely to the radiographic result. Complications were osteoarthritis in three patients, osteonecrosis of the femoral head in one, heterotopic ossification in one, penetration of a screw into the joint in one and iatrogenic sciatic nerve injury in one. The factors affecting the clinical results were fracture patterns, the surgeon's experience, the accuracy of the reduction and late complications.
CONCLUSION
In this present series of posterior wall fractures, as their prognosis depends on the severity of the injury and the accuracy of the reduction, satisfactory result can be obtained by anatomical reduction with thorough preoperative planning and the surgeon's experience.

Keyword

Acetabulum; Posterior wall fracture; Surgical treatment

MeSH Terms

Acetabulum*
Classification
Follow-Up Studies
Head
Hip
Humans
Joints
Medical Records
Ossification, Heterotopic
Osteoarthritis
Osteonecrosis
Prognosis
Sciatic Nerve

Figure

• 

  Fig. 1 Type A1-2 posterior wall fracture by a traffic accident in a 51-year-old man. (A) Preoperative radiographs and CT scan show displaced fracture fragments of the posterior wall with dislocation of the femoral head. (B) Postoperative radiographs and CT scan show anatomical reduction of the fracture and fixation with a lag screw, a spring plate and a reconstruction plate, but a small fracture gap due to comminution of the fracture. (C) Follow-up radiographs 2 years after operation show the normal hip joint without complication. Both clinical and radiographic results are excellent.

• 

  Fig. 2 Type A1-2 posterior wall fracture by a traffic accident in a 24-year-old man. (A) Preoperative radiographs and CT scan show a displaced fracture of the posterior wall with an undisplaced transverse fracture, intra-articular loose body, a fracture of the femoral head, and separation of the symphysis pubis. (B) Postoperative radiographs and CT scan show anatomical reduction and stable fixation of the posterior wall and femoral head fractures. (C) Follow-up radiographs 1.5 years after operation show minor spur at the margin of the femoral head and Grade I heterotopic ossification. The clinical result is good.

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