Outcome of the surgical management of single versus comminuted fractures of the posterior wall of the acetabulum

Abstract

Introduction- Posterior wall fractures of the acetabulum account for 1/3rd of all acetabulum fractures. The comminuted fractures managed surgically have poor outcomes in 30% patients even after anatomical reduction and fixation. The choice of fixation, anatomical reduction and stable fixation are important for better outcomes. Materials And Methods- A total of 27 patients with a minimum age of 18 years were included in the study and managed surgically by fixation by buttress plates and screws in all patients by the Kocher Langenback approach. They were followed up for a minimum follow up of 1 year for their clinical and radiological outcomes. The outcome was assessed at the final follow up as per the Merle de’Aubigne score. Results- The post-operative reduction was anatomical in 18 patients, good in 7 and poor in 2. The clinical outcome as per the modified Merle de’Aubigne score at the final follow up was found to be excellent in 12 (44.4%), good in 8 (29.6%), fair in 3 (11.1%) and poor in 4 (14.8%). The radiological outcome was evaluated as per Matta’s criteria and was found to be excellent in 13 (48.1%), good in 5 (18.5%), fair in 4 (14.8%) and poor in 5 (18.5%). Conclusion- Supplementing the screw fixation of the posterior wall by plates allow for early mobilization of the patients leads to more favorable results in isolated single posterior wall fragment as compared to comminuted posterior wall fragment.