Reconstruction of fractures of the posterior acetabular wall

Abstract

Fractures of the posterior wall of the acetabulum are frequently associated with simultaneous posterior dislocations of the hip and are the most common type of acetabular injury treated today. A wide spectrum of injuries to the posterior acetabular wall can occur from simple nondisplaced fractures of the posterior lip to markedly comminuted, impacted fractures of the entire posterior wall. Most of the fractures of the posterior acetabular wall require open reduction and internal fixation to restore articular congruency, maintain stability of the hip, and provide early mobilization of the patient. A standard posterolateral Kocher-Langenbach approach provides adequate exposure for operative fixation of most posterior wall acetabular fractures. This can be extended by trochanteric osteotomy or triradiate approach, if necessary, to provide fixation of complex posterior wall fractures that involve the posterior or anterior column. This article describes an approach to the operative management of fractures of the posterior acetabular wall when appropriately indicated. Radiographic evaluation, surgical indications, preoperative planning, and surgical technique are discussed.