Tricortical iliac crest graft as a salvageable option in the reconstruction of comminuted posterior wall acetabular fractures: our experience from a level 1 trauma centre.

Abstract

Comminuted fractures of the posterior acetabular wall, pose a significant challengein the reduction and fixation of the fracture fragments and usually result in dubious functional outcomes. Primary reconstruction of the severely comminuted posterior wall using the autologous tricortical iliac crest graft has shown promising results, especially in fractures not amenable for anatomical reduction and fixation. Thus, the present study analyses the functional and radiological outcomes of severely comminuted posterior wall acetabular fractures, primarily reconstructed with an autologous tricortical iliac crest graft. This is a retrospective study, where all cases of comminuted posterior wall acetabulum fractures treated primarily with reconstruction using ipsilateral autologous tricortical iliac crest graft between January 2011 and November 2018 were included. The data of patients were retrieved from the hospital records and all the patients were assessed clinically and radiologically at the final follow-up. Fourteen patients (ten males and four females) were operated on with a mean operative time of 160min (range 125 to 190min) and a mean blood loss of 410ml (range 320ml to 830ml). At 2years of follow-up, 11 patients (78.57%) had good to excellent functional outcomes based on the modified Merle d'Aubigneand Postel scoring system. The radiological assessment using Matta's criteria indicated excellent outcomes in two patients (14.48%), good in six patients (42.85%), fair in six patients (42.85%). Primary reconstruction of the comminuted posterior wall acetabulum fractures is a potential alternative and salvageable option with favourable outcomes. However, it ought to be considered in severely comminuted fractures where anatomical reduction and internal fixation is not feasible.