Application of micro screws in holistic management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation

Abstract

Objective To explore the application of micro screws in holistic management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation. Methods From October 2013 to March 2016, 38 patients (38 hips) were managed for comminuted fracture of posterior acetabular wall combined with posterior hip dislocation. They were 29 males and 9 females, aged from 15 to 71 years (average, 38.6 years). According to the Letournel-Judet classification, there were 35 simple fractures of posterior acetabular wall and 3 complex fractures (2 fractures of posterior column plus posterior wall and one transverse plus posterior wall fracture). All fractures were comminuted and involved the posterior wall. The posterior Kocher-Langenbeck approach was selected for all the patients. Intraoperative exploration revealed the comminuted posterior walls were complicated with broken acetabular rims and ruptured glenoid rims to various degrees. Micro screws or micro screw-plate system were used to repair the comminuted fractures and broken acetabular rims, bridge support fixation with a locking plate followed pelvic reconstruction, and at the same time the ruptured glenoid rims were sutured so that the whole posterior articular structure around the posterior wall was repaired and reconstructed in a holistic manner. Results All the 38 patients were followed up for 12 to 36 months (average, 17.6 months). By the Matta assessment, the reduction was excellent in 36 cases and fine in 2, giving an excellent to good rate of 100%. All fractures got united after 9 to 14 weeks (average, 10.2 weeks). By the improved Merle d'Aubigne & Postel criteria, the clinical outcome was excellent in 35 cases and good in 3, giving an excellent to good rate of 100%. After surgery, heterotopic ossification occurred in one case, and transient paralysis of the sciatic nerve in 3 cases. No infection, necrosis of the femoral head, joint pain, joint malfunction or unstable walking was observed. Conclusion In the management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation, the lesions of the whole posterior wall can be repaired primarily in a holistic manner by repairing the shattered posterior wall of the acetabulum wth micro plate and screw system and simultaneous suture and fixation of the broken actabular rim and ruptured glenoid rim. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Bone nails