Is it necessary to plate all posterior wall fractures of the acetabulum?

Abstract

Background Posterior wall injuries represent the commonest type of acetabular fractures. It could be isolated fractures or − more commonly − associated with hip dislocation with varying degrees of displacement and comminution. Being intra-articular injuries affecting the congruency and stability of the hip joint, 30% of patients with such injuries have poor outcomes. Accurate fracture reduction with stable fixation is the standard way for achieving satisfactory results. This study aims to evaluate the suitability and efficacy − in light of the clinical and radiological results − of using only screws for fixation of certain posterior wall fractures through a limited exposure using the Kocher-Langenbeck approach. Patients and methods This study included 16 cases of displaced posterior wall fractures with single, sizable fragment or multiple, noncomminuted fragments treated with open reduction and internal fixation using only screws through a limited exposure using the Kocher-Langenbeck approach. In 14 cases, fractures were associated with hip dislocation whereas the last 2 cases had isolated posterior wall injuries. Radiological assessment according to Matta and Heeg criteria and clinical evaluation according to Postel score were done postoperatively and throughout the follow-up period that extended for a mean duration of 18.9±6.7 months. Results Clinically satisfactory results (excellent and good) were reported in 14 cases, representing 87.5% of the studied cases. One case was rated fair and one case was rated poor, so unsatisfactory results (fair and poor) were reported in two cases, representing 12.5% of the studied cases. According to the modified criteria of Matta, 12 cases had excellent reduction and four cases had good reduction, and according to the radiographic grading criteria by Heeg, 14 cases were excellent with a normal-appearing hip joint compared with the healthy side; one case was fair with joint narrowing less than 50% compared with the other healthy side with no osteophytes and viable head; and one case was rated as poor with advanced degenerative changes, head subluxation, and severe avascular necrosis. No cases developed heterotopic ossification or implant failure. Conclusion Fixation by only screws through a limited exposure could be a simple and reliable fixation method for certain posterior wall fractures with less soft tissue dissection and intraoperative and postoperative complications, with comparable clinical and radiological results to the more complex fixation methods using conventional reconstruction plates or locked plates.