Abstract
Treatment of both-column fractures with posterior wall involvement is still a controversial topic. This type of posterior wall fracture is different from isolated acetabular posterior wall fracture (AO/OTA62-A1). The aim of this study is to compare the morphology of the posterior wall fragments of these two fracture patterns using computed tomography (CT) scans. All measured data were compared, and the differences between the groups (acetabular both-column fractures with posterior wall involvement were included in group A, and acetabular isolated posterior wall fractures were included in group B) were significant (P ≤ 0.05), including the direction angle, displacement, articular surface-posterior cortex ratio and articular surface area of the fracture fragment. The intraclass correlation coefficient of the measurements included inter-observer (ICC = 0.860) and intra-observer (ICC = 0.853). The morphology of the posterior wall fragments associated with both-column fractures is significantly different from that in isolated acetabular posterior wall fractures, and the treatment of the posterior wall fragment involved in both-column fractures of the acetabulum should be different from that of isolated acetabular posterior wall fractures.
Highlights
In 1964, Judet et al introduced a classification scheme for acetabular fractures that is still in use[1]
Both-column fractures with posterior wall involvement involve front stress fracture of the acetabulum; the trauma is a direct impact transmitted through the greater trochanter to the anterior medial wall of the acetabulum, which is divided into anterior and posterior column fragments when the hip is in external rotation and abduction[13].The femoral head displaces medially, and the posterior wall fragment is pulled by the hip joint capsule anteriorly and is often a large-sized fragment, nondisplaced or minimally displaced, while the joint capsule is intact[7].The mechanism of acetabular isolated posterior wall fracture involves the femoral head striking the posterior acetabular wall with the hip www.nature.com/scientificreports
Tosounidis et al reported that the posterior wall fragment, which is associated with both-column fracture, is created by a “pull-type” mechanism[5] and has a tendency to move anteriorly
Summary
In 1964, Judet et al introduced a classification scheme for acetabular fractures that is still in use[1] In this classification system, posterior wall fractures constitute the most common of the elementary patterns, including isolated and associated fractures (transverse-posterior wall and posterior column-posterior wall fractures)[2]. Previous studies in the literature have adequately reported the treatment and prognosis of these types of posterior wall fractures, suggesting that anatomical reduction and internal fixation are key to achieving good outcomes, unless the hip remains stable[4,5]. Some authors have suggested that combined simultaneous ilioinguinal and Kocher-Langenbeck approaches or extensile approaches are indispensable to obtain adequate visualization and anatomical reduction[8,9] Such approaches have been reported to have significant intraoperative and postoperative complications[10]. The purpose of this study was to compare posterior wall involvement in both-column fractures and isolated posterior wall fractures (AO/OTA 62-A1) of the acetabulum in terms of morphology and to find theoretical support for the treatment protocol of both-column acetabular fractures with posterior wall involvement
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