Treatment of fractures of the posterior wall of the acetabulum

Abstract

Objective To analyze factors which may affect the operative outcome of the posterior wall acetabular fracture retrospectively. Methods In this retrospective study we included 105 patients who had received open reduction and internal fixation for fracture of the posterior wall of the acetabulum from August 1993 to August 2006. All patients were followed up for a mean of 4.1 (range, 2.0 to 10.6) years. Their functional outcomes were evaluated using a modified clinical grading system developed by Merle d' analyses were done to detect associations between clinical outcomes and age, time from injury to surgery, gender, complicated injury, hip dislocation, marginal impaction, reduction, complicated femoral head frac-ture, ectopic ossification and necrosis of femoral head. Results The radiographic result was excellent in 52 patients, good in 36, fair in 12, and poor in 5. The clinical outcome at the time of final follow-up was graded as excellent in 32 patients, good in 56, fair in 11, and poor in 6. There was no obvious association between clinical outcomes and age, time from injury to surgery, gender, complicated injury and hip disloca-tion, but there was obvious association between clinical outcomes and marginal impaction, reduction, com-plicated femoral head fracture, ectopic ossification and necrosis of femoral head. There was a strong associa-tion between clinical outcomes and radiographic grading (Kappa = 0.772) . Conclusions Careful ex-amination, anatomic reduction and stable fixation are keys to a successful operation. Marginal impactian, poor reduction, fracture of femoral head, severe heterotopic ossification and osteonecrosis are risk factors leading to unsatisfactory clinical results. Key words: Acetabulum; Fracture; Fracture fixation, internal; Treartent outcome