Posterior Wall Acetabular Fractures Research Articles

Treatment of old acetabular posterior wall fracture with 3D printing combined with composite plate internal fixation

To explore the application value and clinical effect of three-dimensional printing combined with composite plate internal fixation in the treatment of old acetabular posterior wall fracture. From May 2010 to October 2016, Mimics 19.0 software was used to plan preoperatively according to a 1:1 print pelvic 3D model. At the same time, 23 patients with old acetabular posterior wall fractures were treated with combined plate internal fixation, including 15 males and 8 females, aged 20 to 63 (43.0±5.1) years old, and the time from injury to operation was 23 to 101(47.0±10.5) days. According to Letournel-Judet classification, 11 cases were posterior wall fracture, 7 cases were transverse with posterior wall fracture, and 5 cases were posterior column with posterior wall fracture. All patients were treated with single Kocher-Langenbeck approach combined plate internal fixation, and the evaluation indexes were recorded during operation, after operation and during follow-up. The operation time of 23 patients was (113.5±11.5) min, bleeding was (550.0±104.7) ml and fluoroscopy was (12.7±0.8) s. Matta radiographic reduction criteria were used: excellent in 14 cases, good in 7 cases and poor in 2 cases; 23 patients were followed up for 10 to 24 (16.0±5.6) months. The hip function was evaluated according to the modified Merle d'Aubingne and Postal scoring system at the last follow-up: excellent in 11 cases, good in 8 cases, fair in 3 cases and poor in 1 case. There were 3 cases of traumatic arthritis, 1 case of femoral head necrosis, 2 cases of heterotopic ossification and 5 cases of sciatic nerve irritation. 3D printing technique is an effective and fast method for the treatment of old acetabular posterior wall fractures. In addition, the printing model can provide three-dimensional morphological structure for the operator, combined with preoperative simulation, facilitate intraoperative reduction, and effectively improve the efficiency of surgery.

A preliminary study of three-dimensional printed porous titanium plate integrated implant for the repair of comminuted acetabular posterior wall fracture with bone defect

To explore the feasibility of using computer-aided design(CAD) combined with 3D printing technology to repair and reconstruct the comminuted fracture of the posterior wall of acetabulum with osteochondral defect, to evaluate the biomechanical properties of composite titanium nitride bioceramic coatings with porous titanium alloy scaffolds and steel plate integrated implants. Based on CT images of continuous tomography, the computer-aided design software was used to construct a digital model of porous titanium alloy plate implant with a specially open cellular three-dimensional structure, and the three-dimensional implant was prepared with Ti6Vl4V powder by using the 3D printing technology, following by titanium nitride coating on its articular surface. The degree of matching and attachment between the implant and acetabulum were observed; Ansys software was used for finite element modeling to analyze the stress distribution, stress conduction and deformation displacement of the acetabulum of the normal group, the traditional group and the implant group under the same load state, and to verify the biomechanical properties of the implant. The porous titanium alloy implant fit well with the acetabular bone defects, the shape of the plate was well attached to the bone surface, and it was rated as excellent according to the Matta criteria. The Von Mises stress peak of the implant group 13.38 MPa was close to the normal group 13.11 MPa and smaller than that in the traditional group 15.66 MPa. The Von Mises stress distribution and conduction of implant group were basically consistent with the normal group, slightly better than the traditional group; the maximum relative displacement of the implant was 0.166 mm, according to the finite element analysis. The porous titanium alloy stent plate implant with titanium nitride coating prepared by 3D technology has excellent matching degree and biomechanical properties; the anatomical reconstruction makes the stress distribution and conduction recovery well, close to normal hip joints, which provides a new option for the clinical treatment of comminuted posterior acetabular wall fractures with severe bone defects.

Precontoured buttress plate vs reconstruction plate for acetabulum posterior wall fractures: A biomechanical study.

BACKGROUNDThe purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although “special shaped precontoured plates” have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking.AIMTo evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates (CCRPs) for posterior wall acetabulum fracture treatment.METHODSTwelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models (experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures (of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate (PABP). Samples were placed through the test device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1.RESULTSThe average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99 ± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs (P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL (posterosuperior fracture line vertical to the ground surface) and CL (posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs (P = 0.036 and P = 0.045, respectively). According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL (posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs (P = 0.261).CONCLUSIONPABP provides more stable fixation in acetabulum posterior wall fractures than 5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.

Cortical Impaction in Posterior Wall Acetabular Fractures

To report the incidence of patients with extra-articular posterosuperior acetabular cortical impaction associated with a posterior wall acetabular fracture-dislocation. Retrospective case series. Regional Level 1 trauma center. Ninety-seven patients who sustained an isolated posterior wall acetabular fracture-dislocation from July 2007 until July 2017. The medical record and the computed tomography (CT) scan of the abdomen and pelvis were reviewed including axial, coronal, and sagittal reconstruction images and 3D surface renderings. Each pelvic CT scan was evaluated for impaction of the extra-articular posterosuperior acetabular cortical surface associated with posterior wall acetabular fracture-dislocations. The reduction accuracy was assessed for each patient with cortical impaction using postoperative CT scans. The final attending radiology report was reviewed to see whether the cortical impaction was noted. Four of the 99 patients (4.12%) had identifiable areas of cortical impaction on preoperative CT imaging. Reduction accuracy demonstrated 1 anatomical reduction, 2 imperfect reductions, and 1 poor reduction. The final attending radiologist report did not comment on any patient with cortical impaction. Our study demonstrates that a small number of patients sustain cortical impaction of the posterosuperior acetabular cortical surface along with their posterior wall acetabular fracture-dislocation. Although uncommon, preoperative imaging should be scrutinized to identify this clinical entity. As part of the preoperative plan, the surgeon can anticipate the cortex available for reduction verification and whether any additional steps or altered surgical approaches are needed to achieve an anatomical reduction. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

An Unusual Presentation of Pubic-type Anterior Hip Dislocation with Concomitant Anterior and Posterior Acetabular Wall Fracture

Anterior hip dislocation is uncommon, comprising only 5%-15% of hip dislocations. It usually occurs following a severe external rotation and abduction injury. These injuries are occasionally associated with acetabular fractures, which generally occur in the direction of dislocation. We describe a rare case of pubic-type anterior hip dislocation with concomitant anterior and posterior acetabular wall fractures in a young male following a road traffic accident. The dislocation could not be reduced by closed means and open reduction had to be performed. Reduction of the hip allowed the wall fragments to fall back to their place and the hip remained stable. At the one-year follow-up, the clinical and radiological results were excellent. This case also emphasizes the importance of early diagnosis and prompt reduction in the successful management of these types of injury.

Acute total hip arthroplasty versus open reduction internal fixation for posterior wall acetabular fractures in middle-aged patients.

Introduction:Open reduction internal fixation (ORIF) is the standard of care for displaced acetabular fractures, but the inability to achieve anatomic reduction, involvement of the posterior wall, articular impaction, and femoral head cartilaginous injury are known to lead to poorer outcomes. Acute total hip arthroplasty (THA) is a reasonable treatment option for older patients with an acetabular fracture and risk factors for a poor outcome, but it is only described in case series. The purpose of this study is to compare outcomes of ORIF and acute THA in middle-aged patients with an acetabular fracture from a single center.Methods:Retrospective case-controlled study of patients aged 45 to 65 years old with acetabular fractures involving the posterior wall treated with acute THA or ORIF at a level 1 trauma center between 1996 and 2011. Patients were matched by fracture pattern and age at a 2 (ORIF):1 (acute THA) ratio. Functional outcome, complications, and reoperation rates of acute THA and ORIF were compared.Results:Sixteen acute THA patients (average age 56.4 years) and 32 ORIF patients (average age 54.3 years) were evaluated at an average follow-up of 6.2 years (range 1–15.2). The average Oxford Hip Score in the acute THA group was 44 compared to 40 in the ORIF group (P = .075). Complication rates were similar between both the groups. Twelve hips (37%) in the ORIF group had undergone THA or been referred for THA, and 2 revisions (13%) had occurred in the acute THA group. A Kaplan–Meier survival analysis showed that those undergoing acute THA had significantly better survival of their index procedure (P = .031).Conclusions:Both ORIF and acute THA for high-energy acetabular fractures involving the posterior wall in middle-aged patients can provide excellent results, with acute THA patients achieving improved survival of the index procedure and improved functional scores.

Supplemental Superior Buttress Plating for the Treatment of Posterosuperior Wall Acetabulum Fractures

Posterosuperior wall acetabulum fractures are a unique and uncommon fracture pattern. Traditional plate fixation may not provide adequate fixation of these fracture fragments. This article presents a surgical technique and the results of a case series using a supplemental 1/3 tubular superior buttress plate to improve fracture reduction and better neutralize shear forces in the treatment of superior posterior wall fractures. Additionally, we compared failure rates of those posterior superior wall acetabular fractures treated with supplemental superior buttress plates to those treated with standard plate fixation and no supplemental superior buttress plates.

Crescent Technique with Dual C-Shaped Reconstruction Plates for Posterior Acetabular Wall Fractures

Background: Here we have defined a novel technique for repairing posterior acetabular wall fractures called the “crescent technique,” in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method. Patients and Methods: This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0–15 days) after the trauma. The mean follow-up period was 19 months (13–29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d’Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta. Results: In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002). Conclusions: The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.

Progress in treatment and research of acetabular posterior wall fracture

Fracture of the posterior wall is the most common type of acetabular fractures, but it is often associated with such injuries as dislocation of hip joint, femoral head fracture and lesion of sciatic nerve. Latest researches have found that treatments of fracture of the acetabular posterior wall often lead to unsatisfactory outcomes because its prognosis is influenced by a variety of factors, including its associated injuries, subtypes, and quality and timing of surgical reduction. This review summarizes extensive clinical experiences in treatment of the fracture and available literature concerning management and research of the fracture so as to provide enough information for junior surgeons to have a better understanding of the fracture and its treatment, improving the prognosis of the fracture and effectively avoiding the pitfalls in their clinical practice. Key words: Acetabularum; Therapy; Complications; Posterior wall fracture; Assessment

Management of acetabular wall fractures with hip dislocation: A case series

Introduction: Posterior wall fractures are the most common type of acetabular fractures. Comminuted fractures with extensions to acetabular roof are associated with poor prognosis. Accurate evaluation of resuting union and likelihood of future arthritis or AVN of femoral head are also hindered. Materials and methods: We report a case series of 9 cases with posterior wall acetabulum fractures associated with posterior dislocation of femoral head treated with internal fixation of posterior wall by three step reonstruction-1)open reduction of dislocation, 2)preservation of soft tissues and reconstruction of marginally impacted and osteochondral fragments using screws, 3)final reinforcement with buttress plating. Functional outcome was evaluated according to D’aubigne and Postel criteria and radiological outcome by criteria of Matta. Results: According to criteria of Matta 44% had excellent, 34% had good and 22% had fair results. According to D’aubigne and Postel criteria 50% had excellent results, 37.5% had good results, 12.5 % had fair results. None of the cases had heterotrophic ossification. Wound site infection eas the only complication encountered. Conclusion: We conclude that this three step rconstruction procedure in management of posterior wall acetabular fracture with posterior dislocation of femoral head results in satisfactory functional and radiological outcome without complications.

Single versus double column fixation in transverse fractures of the acetabulum: A randomised controlled trial

IntroductionBiomechanical studies have compared fixation methods in transverse acetabular fractures, yet there is not enough clinical data to suggest an optimal fixation method. The aim of this randomized controlled trail was to compare fracture stability in posterior plating alone versus posterior plating and anterior column lag-screw fixation in treatment of transverse and transverse with posterior wall acetabular fractures. MethodsThirty patients were randomized to one of two groups, either posterior fixation alone (single column group), or posterior plating and anterior fixation with percutaneous anterior column screw (double column group). Patients were followed up with serial radiographic assessments documenting any loss of reduction, utilizing Matta’s radiological criteria, measuring the roof arc angles and by measuring any change in the femoral head offset. ResultsFifteen patients were randomized to each group. Mean patient age was 31 years, mean follow up period was 19 months (range 12–24). There was no significant differences between the two groups with regards the quality of post-operative reduction, blood loss, hospital stay and functional score using the modified Merle D'Aubinge and Postel score. The operative time was significantly longer in the double column fixation group (130 min versus 104 min). There was no loss of reduction observed in either of the two groups. ConclusionSingle poster column fixation in transverse and transverse posterior wall fractures showed similar result to double column fixation, in terms of fractures stability in the follow up period, quality of reduction and early functional outcome.

Neglected posterior acetabular wall fracture managed with uncemented total hip arthroplasty with posterior wall reconstruction by femoral head autograft: a case report

<p class="abstract">Total hip arthroplasty (THA) poses several challenges as a treatment option for acetabular fracture especially in the setting of a neglected fracture. The potential technical challenges of THA include the altered anatomy and hip centre, acetabular bone deficit, difficulty in achieving long-term fixation of the acetabular shell and risk of nerve injury. In our case, a forty two years old, male labrourer presented with a five months old injury, which was previously managed only conservatively. Preoperative evaluation revealed displaced posterior wall acetabulum with superiorly migrated femur head with flattened contour. We managed the case with uncemented THA. The acetabular defect was addressed using the femoral head autograft which was secured with screws. On three months follow up, radiographical evalution showed good graft consolidation without any acetabular component migration and functionally a Harris hip score of 76. Thus, in case of neglected acetabular fractures, with high probability of post traumatic arthritis to develop, THA remains the preferred choice of management. Albeit challenging to perform, THA provides effective way to decrease pain, improve stability and increase functional outcomes<strong>.</strong></p>

Application of micro screws in holistic management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation

Objective To explore the application of micro screws in holistic management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation. Methods From October 2013 to March 2016, 38 patients (38 hips) were managed for comminuted fracture of posterior acetabular wall combined with posterior hip dislocation. They were 29 males and 9 females, aged from 15 to 71 years (average, 38.6 years). According to the Letournel-Judet classification, there were 35 simple fractures of posterior acetabular wall and 3 complex fractures (2 fractures of posterior column plus posterior wall and one transverse plus posterior wall fracture). All fractures were comminuted and involved the posterior wall. The posterior Kocher-Langenbeck approach was selected for all the patients. Intraoperative exploration revealed the comminuted posterior walls were complicated with broken acetabular rims and ruptured glenoid rims to various degrees. Micro screws or micro screw-plate system were used to repair the comminuted fractures and broken acetabular rims, bridge support fixation with a locking plate followed pelvic reconstruction, and at the same time the ruptured glenoid rims were sutured so that the whole posterior articular structure around the posterior wall was repaired and reconstructed in a holistic manner. Results All the 38 patients were followed up for 12 to 36 months (average, 17.6 months). By the Matta assessment, the reduction was excellent in 36 cases and fine in 2, giving an excellent to good rate of 100%. All fractures got united after 9 to 14 weeks (average, 10.2 weeks). By the improved Merle d'Aubigne & Postel criteria, the clinical outcome was excellent in 35 cases and good in 3, giving an excellent to good rate of 100%. After surgery, heterotopic ossification occurred in one case, and transient paralysis of the sciatic nerve in 3 cases. No infection, necrosis of the femoral head, joint pain, joint malfunction or unstable walking was observed. Conclusion In the management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation, the lesions of the whole posterior wall can be repaired primarily in a holistic manner by repairing the shattered posterior wall of the acetabulum wth micro plate and screw system and simultaneous suture and fixation of the broken actabular rim and ruptured glenoid rim. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Bone nails

Use of Spring Plates in Fixation of Comminuted Posterior Wall Acetabular Fractures.

Surgical management of comminuted posterior wall acetabular fractures with marginal fragments remains difficult. The purpose of this study was to evaluate the use of spring plates as adjunctive fixation in comminuted posterior wall acetabular fractures. A retrospective review of patients treated for posterior wall acetabular fractures with the use of customized spring plates as adjunctive fixation between 2000 and 2017 was performed. Patients were evaluated radiographically according to the grading criteria of Matta. Complications including subsequent revision surgery and hardware failure were recorded. Fifty-two patients underwent surgical fixation of posterior wall acetabular fractures with the use of customized 3.5-mm spring plates combined with posterior buttress compression plating over the spring plates as definitive fixation. Mean follow-up was 13.9 months (range: 3-140 months). Forty-two patients had radiographic grades of excellent, with 6 good, 1 fair, and 3 poor. There were no hardware complications. Five patients underwent revision surgery, including 4 patients (7.7%) who underwent a total hip arthroplasty due to advanced arthritis. The use of customized spring plates is a viable method of adjunctive fixation for comminuted posterior wall fractures with marginal fragmentation. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Correlation of stability and complications measurements in traumatic hip dislocation cases associated with posterior wall acetabular fracture

Correlation of stability and complications measurements in traumatic hip dislocation cases associated with posterior wall acetabular fracture

Instability of the Hip Joint After Posterior Acetabular Wall Fracture: Independent Risk Factors Remain Elusive.

Exact determinants of hip instability have not been established for fractures of the posterior wall of the acetabulum involving ≤50% of the wall. Therefore, examination of the hip under anesthesia (EUA) is routinely performed. Recently, the superior exit point of the fracture has been reported to be an important identifiable risk factor. Pre-existing adult hip dysplasia (developmental dysplasia of the hip [DDH]) is thought to have a similar role. The purpose of this study was to determine if any known radiographic measurements and signs associated with DDH, or any fracture characteristics, are independent risk factors for hip instability after fracture of the posterior wall of the acetabulum. All patients with a posterior acetabular wall fracture (OTA 62.A1) treated at our institution between 2004 and 2015 were considered for the study. Inclusion criteria were an age of ≥18 years, an isolated posterior acetabular wall fracture involving ≤50% of the acetabular wall, adequate imaging, and documented EUA results. Evaluated variables included fracture fragment size, superior exit point of the fracture, center-edge angle, acetabular index, Tönnis angle, lateralized head sign, crossover sign, posterior wall sign, ischial spine sign, and hip version. Data were examined using univariate testing, followed by a multivariate logistic regression analysis. Sixty-eight patients met all of the inclusion criteria. Univariate analyses identified the posterior wall sign (p = 0.033), ischial spine sign (p = 0.030), and proximity of the superior exit point of the fracture to the acetabular dome (p = 0.044) as having a significant association with hip instability. However, multivariate logistic regression modeling revealed that none of these factors were significant independent risk factors. Consistent with previous studies, univariate analyses identified certain radiographic findings as significant risk factors for hip instability in the setting of a fracture of the posterior wall of the acetabulum. However, subsequent multivariate logistic regression modeling showed that no studied variable was an independent risk factor. Our results indicate that important factors leading to hip instability are yet to be identified or the contributions of the measured variables are relatively small. Therefore, EUA should remain the main clinical determinant of hip stability status. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Discrete element analysis is a valid method for computing joint contact stress in the hip before and after acetabular fracture

Evaluation of abnormalities in joint contact stress that develop after inaccurate reduction of an acetabular fracture may provide a potential means for predicting the risk of developing post-traumatic osteoarthritis. Discrete element analysis (DEA) is a computational technique for calculating intra-articular contact stress distributions in a fraction of the time required to obtain the same information using the more commonly employed finite element analysis technique. The goal of this work was to validate the accuracy of DEA-computed contact stress against physical measurements of contact stress made in cadaveric hips using Tekscan sensors. Four static loading tests in a variety of poses from heel-strike to toe-off were performed in two different cadaveric hip specimens with the acetabulum intact and again with an intentionally malreduced posterior wall acetabular fracture. DEA-computed contact stress was compared on a point-by-point basis to stress measured from the physical experiments. There was good agreement between computed and measured contact stress over the entire contact area (correlation coefficients ranged from 0.88 to 0.99). DEA-computed peak contact stress was within an average of 0.5 MPa (range 0.2–0.8 MPa) of the Tekscan peak stress for intact hips, and within an average of 0.6 MPa (range 0–1.6 MPa) for fractured cases. DEA-computed contact areas were within an average of 33% of the Tekscan-measured areas (range: 1.4–60%). These results indicate that the DEA methodology is a valid method for accurately estimating contact stress in both intact and fractured hips.

Surgical treatment of marginal osteochondral impaction in acetabular fractures.

Clinical and radiological evaluation of the results of the technique of elevation and grafting of osteochondral marginal impaction fragment of posterior wall acetabular fractures. Twenty patients available for this study had fracture acetabulum with marginal impaction fragment. Elevation, reduction and bone graft impaction of the defect were the technique in all cases. Follow-up was at least for 1year. Evaluation of patient was done clinically by modified Merle d'Aubigné and Postel score and radiologically by Matta's criteria of reduction quality and that of radiological hip evaluation. Ficat criteria for avascular necrosis and Brocker criteria were used for evaluation of heterotopic ossification. Radiologically, according to the Matta's criteria of reduction quality there were anatomic reduction in 16 patients (80%) and satisfactory reduction in 4 patients (20%). Clinical assessments based on modified Merle d'Aubigné and Postel score include 4 (20%) excellent scores, 12 (80%) good scores, 3 (15%) fair results and poor in one patient who had revision by total hip replacement. Diagnose of marginal impaction fragment preoperatively makes operative technique by elevation, reduction, bone graft packing and fixation mandatory to obtain anatomic reduction and favorable outcome. This technique should be completed before final fixation of the main fracture acetabulum.

Surgical Treatment of Unstable Posterior Wall Acetabular Fractures

: Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Aim: To evaluate the results of surgical treatment of unstable posterior wall fractures with open reduction and internal fixation. Patients and Methods: In this study, 16 patients with unstable posterior wall acetabular fractures. As regard age of the patients, it ranged from 20- 60 years with mean 32.8±9.12 years. They were 12 males and 4 females. The cause of trauma was road traffic accident (RTA) in all patients. All patients were operated upon with open reduction and internal fixation using reconstruction plates and cancellous screws for treatment posterior acetabular fracture in the period from March 2014 to March 2016 with follow up period ranging from 2 months to 2 years. Results: Satisfactory functional outcome was obtained in 12 cases, excellent in 5 and good in 7 cases, while unsatisfactory functional outcome was obtained in 4 cases, fair in 3 and poor in one. Conclusions: Open reduction and internal fixation is an effective method for treatment of unstable posterior acetabular wall fractures. Surgical treatment leads to early rehabilitation and avoiding complications as osteoarthritis

Effects of the acetabular fracture index and other factors of posterior wall acetabular fracture on functional outcome.

ObjectiveTo analyze the effects of the acetabular fracture index (AFI) and other factors on the functional outcome of patients with acetabular fractures involving the posterior wall.MethodsForty-eight patients who underwent surgery in our department were reviewed. According to the AFI, which indicates the percentage of remaining intact posterior acetabular arc, the patients were divided into Group A (AFI ≤ 25%, 11 patients), Group B (25% < AFI ≤ 50%, 23 patients), Group C (50% < AFI ≤ 75%, 7 patients), and Group D (75% < AFI ≤ 100%, 7 patients). The AFI was measured with a computed tomography picture archiving and communication system or calculated with the cosine theorem. A nonparametric test and ordinal regression were used to determine the role of the AFI and other factors on the functional outcome. Perioperative information, including demographic and fracture-related data, reduction quality, physical therapy duration, association with a lower limb fracture and avascular necrosis of the femoral head were prospectively gathered.ResultsThe mean AFIs of A, B, C, and D groups were 14.3%, 35.9%, 59.5%, and 81.2%, respectively. No statistically significant differences were observed among the groups for demographic and fracture-related data. A better reduction quality (OR = 4.21, 95%CI 1.42 ∼ 12.43, χ2 = 6.781, P = 0.009) and a larger value of AFI (OR = 2.56, 95%CI 1.18 ∼ 5.55, χ2 = 5.648, P = 0.017) result in a higher functional score. The functional outcome of a physical therapy duration of more than 12 months (OR = 0.15, 95%CI 0.02 ∼ 0.90, χ2 = 4.324, P = 0.038) was better than that of less than 12 months. Lower limb fracture (OR = 0.13, 95%CI 0.02 ∼ 0.74, χ2 = 5.235, P = 0.022) and avascular necrosis of femoral head (OR = 0.02, 95%CI 0.00 ∼ 0.87, χ2 = 4.127, P = 0.042) were found to correlate with a lower functional score.ConclusionWith a greater of AFI, the functional outcome score would be better. Other factors, including reduction quality, physical therapy duration, association with a lower limb fracture, and avascular necrosis of the femoral head, most likely also affect hip functional recovery.