Imperfect Reduction Research Articles

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.

Blocking screws for intramedullary nail guidance

Intramedullary nails (IMNs) are commonly used for fracture fixation of the femur and tibia, and internal lengthening nails (ILNs) can be used for deformity correction and limb lengthening. While this form of fixation has demonstrated substantial success, one major limitation is imperfect reduction and malalignment, particularly when used for fractures or osteotomies in the metaphysis. One means of overcoming this challenge is through the use of blocking screws, given their ability to guide the path of the nail, decrease the width of the medullary canal, and maintain reduction. In this literature review, indications, techniques, outcomes, and complications are reported. Searches of PubMed and The Cochrane Collaboration were performed. Technique articles and single case reports were not reviewed. All other English studies reporting outcomes of IMN or ILN fixation of the femur or tibia with concomitant use of blocking screws were reviewed. Blocking screws have been used successfully in the lower extremity for both trauma and in deformity surgery. Key techniques are placing the screws in the concavity and perpendicular to the plane of deformity, with adequate distance from the planned path of the nail and from the fracture or osteotomy site. Current data suggest high rates of union with adequate alignment and a low complication rate, although most studies are small, retrospective case series. Blocking screws appear to be a reasonable strategy for achieving fixation in difficulty, metaphyseal segments. Further, well-designed prospective studies should be carried out to make more definitive conclusions.

Investigating carbon emissions in a production-inventory model under imperfect production, inspection errors and service-level constraint

This paper discusses an integrated inventory model for vendor-buyer system with stochastic demand and service-level constraint. The buyer's demand follows a normal distribution and the lead time depends upon lot size. The buyer uses a periodic review policy to manage the inventory level. An imperfect production processes and inspection errors are considered in the model. Carbon emissions and energy impacts which are generated from transportation activity and production activity are also included in the model. An incentive and penalty policy are adopted to reduce the carbon emissions generated from supply chain system. The model contributes to the current literature by allowing the inclusion of imperfect production, inspection errors, carbon emissions and setup cost reduction. The objective of the model is to determine the review period, setup cost and the number of deliveries so that the total cost incurred has the minimum value. An iterative procedure is suggested to solve the model. A numerical example and sensitivity analysis are performed to illustrate the application of the model and to show the impact of the changes of key parameters on model behaviour.

A simple reduction technique for the posterior column in acetabular fractures

Background Posterior acetabular column injuries can happen as an isolated fracture or can be associated with other acetabular fractures. The aim of this study was to evaluate the validity of a new technique in the reduction and fixation of fractures involving the posterior acetabular column. Patients and methods A prospective study which included 35 patients with displaced acetabular fractures (≥3 mm). Of the patients, 24 were men and 11 were women. The age of the patients’ ranged from 25 to 50 years with a mean of 37.9 years. All patients had injuries to the posterior column, either isolated or associated with other types of acetabular fractures. The follow-up period ranged from 24 to 36 months with a mean of 28.8 months. Results Perfect or anatomical reduction of the posterior column was achieved and maintained in 25 (71.43%) patients. Near perfect or near-anatomical reduction of the posterior column was achieved and maintained in another six (17.14%) patients. Three (8.57%) patients had good reduction of the posterior column which was maintained till union, while one (2.86%) patient had imperfect reduction of the posterior column. According to the Harris hip score, the clinical outcome was excellent in 12 (34.29%) patients, good in 17 (48.57%) patients, fair in five (14.29%) patients, and poor in one (2.85%) patient. The operative time for reduction and fixation of the posterior column using this technique ranged from 15 to 20 min with a mean of 18 min. No permanent complications happed during this study. Conclusion The technique described in this study is a simple technique for open reduction without the need for such bulky instrumentations with rapid internal fixation. This method of reduction and fixation is considered useful, safe, and comparable to all the previous described reduction and fixation techniques.

Aspect Regarding Plastic Deformations in Tibial Plateau Fractures

Our purpose was to study tibial plateau fractures considering the rise of their incidence, their potential immediate seriousness or late complications and their complexity. We realized a clinical-statistical study concerning the incidence of tibial plateau fractures taking in account critaeria like age, sex, mechanism of injury, fracture type and correlations between these. The study involves 126 patients, 98 (77.77%) being treated surgically and 28 (22.22%) conservatory between 2008-2016 in the I-st Clinic of Orthopaedics and Traumatology Timisoara. Approximately 2/3 of cases are of Schatzker type I, II and III. Type VI Schatzker occured in 5.78% of all, the mechanism of injury being split almost equal between road accidents and falls from height. Road accidents prevale as a causing circumstance of tibial plateau fractures. 2/3 of the tibial plateau fractures associate with other significant regional lesions. Bone lesions are not rarely underestimated by plain radiographs. Therefore evacuation of haemarthrosis (showing lipohaemarthrosis) and high performance imaging (CT, MRI) are often needed. In comparison to other fracture sites, imperfect reduction of tibial plateau fractures results more frequently in long term sequellae. Being frequently complex, comminuted fractures with associated regional lesions tibial plateau fractures raise the complexity of the medical act from establishing a complete diagnosis to the final therapeutic measures. For a correct and complete preoperatory diagnosis frequently high performance imaging is needed. Tibial plateau fractures significantly affect patients, the healthcare and social-economic system, the healing and rehabilitation.

Functional outcome of acetabular fracture fixation by modified Stoppa’s approach

<p class="abstract"><strong>Background:</strong> We analysed the clinical and functional outcome of acetabular fracture treated by Modified Stoppa approach. In this study, we also analysis Intraoperative and post-complications of fractures treated by the modified Stoppa apprpoach.</p><p class="abstract"><strong>Methods:</strong> All of the, 20 patients who needed the anterior approach for the treatment of acetabular fracture at our hospital from May 2016 To May 2018, were subjected to surgery via modified Stoppa approach. Pre-operative Anterior posterior (AP) view and Judet and CT scan were done to classify the fracture. Functional outcome was assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication were assessed by retrospectively analyzing medical records and radiographics examination.<strong></strong></p><p class="abstract"><strong>Results: </strong>The clinical results were excellent in 12 cases , very good 2 in cases and good in 1 cases , fair in 1 case and poor in 4 cases. Athough the radiological 12 cases had anatomical reduction, 5 imperfect reduction and 3 poor reduction.</p><p class="abstract"><strong>Conclusions:</strong> It can be concluded that the modified Stoppa approach could be used as an alternative to the ilioinguinal approach. It’s provides excellent access and visulaistion to the anterior column and quadrilateral surface and the rates of complication were less as compare to ilioinguinal approach.</p>

Influence of modifying composition of gypsum binders on the structure of composite materials

At present, the modern society utilizes composite materials in various branches of the national economy. The properties of such materials depend on their composition and structure, and may considerably differ from the properties of source materials. In turn, texture and structure of crystals, their packing order, size and level of sophistication affect the structure of materials. This is particularly demonstrated by hydration curing materials on the basis of gypsum and magnesia binding materials, as well as portland cement. Structuring control is one of the key problems of composite materials. Gypsum binding materials with various modification composition are suggested as a model system to study the influence of texture and structure of materials on their properties. One of them is the construction gypsum – an anhydrite binder and a multiphase gypsum binder (MGB). Scanning electron microscopy (SEM) was chosen as the main method of study. It is found that gypsum crystals that are formed during hydration and curing of gypsum binders with various modification composition have different texture and structure. It prevents from getting the optimal packing of a material. It is justified and confirmed that the MGB consisting of several modifications of calcium sulfate allow choosing the best material composition due to the combination of crystals having different size and form. Besides, MGB contains significant amounts of insoluble anhydrite that reduces the water-gypsum ratio of a binder and compacts its structure. Considerable attention is paid to microfillers, which significantly affect the texture and structure of materials based on gypsum binders. Iron ore concentrate of the Lebedinsky GOK generally consisting of magnetite, as well as impalpable flour cullet waste of sodium and potassium glass were used as microfillers in the given study. Ultra- and nanodispersed powders at their introduction to gypsum and anhydrite compositions change the size and morphology of crystal newgrowths and ensure the formation of ordered, denser and uniform fine-crystalline structures of composite materials, which leads to the reduction of structure imperfection, porosity and increase in contact areas of crystalline hydrates increasing physical and mechanical performance of gypsum materials. Efficient composite construction materials are obtained on the basis of MGB and microfillers.

Management of anteromedially displaced acetabular fractures using a collinear reduction clamp through modified ilioinguinal approach

The authors present a surgical technique using a collinear reduction clamp through the modified ilioinguinal approach (MIA) for anteromedially displaced acetabular fractures along with the surgical outcomes. Between October 2010 and June 2015, 15 patients underwent surgical treatment for anteromedially displaced acetabular fractures; 10 both-column fractures and 5 anterior column and posterior hemitransverse fractures. Anteriorly displaced anterior column fragment and medially displaced quadrilateral plate fragment were simultaneously reduced using a collinear clamp and fixed with a 3.5mm-reconstruction plate through MIA. Postoperatively, anatomical reduction was achieved in 12 patients, while imperfect reduction was achieved in 3. At a mean follow-up of 49.0 months (range, 24–93 months), the mean Postel Merle d’Aubigné score were 16.3 and the mean VAS score was 0.9. Final radiographic grades according to Matta system were excellent in 13 patients and good in 2. Surgical technique using a collinear reduction clamp through the MIA can provide satisfactory outcomes in anteromedially displaced acetabular fractures.

Exploring the relationship between CSR performance and financial constraints: empirical evidence from European firms

This paper investigates the relationship between corporate social responsibility (CSR) activities and financial constraints. Our panel dataset consists of 397 European companies listed in the STOXX Europe 600 during 2009–2014. The findings reveal that firms with higher CSR performance exhibit lower degree of financial constraints. In addition, the link between CSR performance and financial constraints is a fully mediated relationship. The negative effect of CSR performance on financial constraints follows the path through mitigating agency conflicts of free cash flow and information asymmetry. The findings suggest that one mechanism linking CSR performance and financial constraints is a reduction of capital-market imperfections.

Less Invasive Anterior Iliac Approach and Compression Osteosynthesis for the Treatment of High Anterior Column Fractures of the Acetabulum.

BackgroundDisplaced anterior column fractures have increasingly been treated surgically by the ilioinguinal approach and fixation with lag screws and a buttress plate on the pelvic brim. However, a major disadvantage of the ilioinguinal approach is possible damage to the neurovascular bundle and the lymphatic structures in the intermediate part of the approach. This study aims to present a novel surgical technique of the less invasive anterior iliac approach and compression osteosynthesis for high anterior column fractures of the acetabulum.MethodsIn this retrospective case series, 19 patients treated operatively for isolated high anterior column fractures using the less invasive anterior iliac approach and compression osteosynthesis were included. Patient demographics, the cause of injury, associated injuries, time to surgical reconstruction, and operation time were collected from the medical records. The quality of reduction was assessed by postoperative standard radiographic views and computed tomography scans and graded according to Matta's criteria. Clinical and radiographic grades were assessed according to Matta's criteria at the last follow-up.ResultsThis less invasive surgical technique was successful for reduction and fixation in all high anterior column fractures and provided sufficient stability to allow immediate mobilization of the patients after surgery. Twelve fractures were combined with the quadrilateral plate fracture and seven fractures did not involve the quadrilateral plate. According to Matta's criteria, anatomical reduction was obtained in 17 patients and imperfect reduction in two patients. Clinical results were excellent in 17 patients and good in two patients. Radiographic results were excellent in 17 patients and good in two patients. Ten patients had neurapraxia of the lateral femoral cutaneous nerve related to the approach, which was resolved completely in seven. One patient had deep vein thrombosis.ConclusionsOur less invasive surgical technique of the anterior iliac approach and compression osteosynthesis is a useful addition to the existing techniques in the treatment of high anterior column fractures of the acetabulum. Despite being a limited approach and fixation, this technique provides sufficient exposure for reducing and fixing the fracture and adequate stability to allow immediate mobilization of the patient after surgery.

CT based management of high energy tibial plateau fractures: A retrospective review of 53 cases

ObjectivesThe management of high energy tibial plateau fractures is a surgical challenge. Recently described Luo’s classification is based on CT scans and is more objective with a better inter-observer agreement as compare to Schatzker and AO/OTA classifications. We describe the functional results of a series of 53 cases classified and managed according to the Luo’s column concept. MethodsA retrospective review of 53 high energy tibial plateau fractures, operated between January 2012 and March 2015 at a Level I trauma center, was performed. CT scans were used to classify these injuries based on the number of columns involved. Plating configuration and surgical approach were chosen based on the number of independent articular fragments on axial sections at the level of fibular head. Results1 one-column, 51 two-column and 1 three-column fractures were studied. Triple plating was done in 5 patients. Mean follow-up was 2.7 years and mean Insall Knee score was 95.42. Four patients had varus malalignment and 1 had joint depression in the post-operative period. These were due to imperfect reduction during the surgery itself, and no case of late collapse was detected. ConclusionUtilizing Luo’s classification for treating these complex injuries will assist in better understanding of fracture pattern and hence help in achieving a better functional outcome. Each fractured column needs to be independently addressed.

Trimming of imperfect hemispherical shell including point mass distributions

Generally, a hemispherical shell is well-known simple structure for application in engineering fields such as Hemispherical Resonator Gyroscope (HRG), Energy Harvester (EH), etc. In this regard, numerous researchers have investigated the perfect shell model to analyze vibration characteristics due to the conciseness to manufacture the structure. However, a slight imperfection on the structure may result in significant inaccuracy of a signal in the practical point of view. Actually, frequency difference due to the irregularity of structure induces error on the resonator, and thus the reduction of imperfections can be a crucial feature during the operation of devices. As a method for controlling motion as well as characteristic in the vibration, the eliminating frequency split, in other words “trimming”, is introduced in this study. To obtain the eigenfrequency and to model the point masses, Rayleigh's energy method is applied to get the analytical solution. In order to show the accuracy of present study, data are compared with COMSOL Multiphysics®. Finally, the trimming mass is analytically predicted by the function of initially attached masses and angular positions.

Surgical treatment for Pipkin type IV femoral head fracture.

Pipkin type IV femoral head (FH) fracture was thought as poor prognosis. There were several surgical approaches and treatments for this difficult fracture. However, there was no one treatment superior to another. We reviewed a serious of patients with Pipkin type IV FH fracture underwent surgery via a modified Gibson approach. We reviewed a consecutive series of nine patients with Pipkin type IV FH fracture under surgery via a modified Gibson approach between 2012 and 2013. The surgical procedure was completely described, and the radiological outcome and the functional outcome were also reviewed. The mean follow-up duration was 17 (12-30) months. The mean Merle d'Aubigne score was 16 (8-19). Seven patients had anatomical reductions, and two had imperfect reductions by Matta's grading. There was no early posttraumatic osteoarthritis during the follow-up period. One patient with early post-traumatic osteonecrosis 3 months after index surgery underwent total hip arthroplasty. Through this surgery approach to fix the FH and the acetabulum, the radiological and the functional results were satisfactory. We still need more patients with prospective study to find an optimal surgical approach for Pipkin type IV FH fracture.

Clinical and radiological outcome of surgical fixation of femoral head fractures

Background Up to 16% of hip dislocations have associated femoral head fractures, but if incongruency and instability of hip occurred this is an indication for surgery; intervention could range from excision of the fractured part, fixation, or even total hip replacement. Approaches may be anterior or posterior or transtrochanteric. Except for the surgical dislocation of the hip these approaches give limited exposure; surgical dislocation gives access to 360° of the head femur. Patient and methods A retrospective study for prospectively collected data, started by 23 cases and after exclusion of those cases treated conservatively or by excision, or any intervention other than fixation, there were 12 cases left on which the study was conducted. The study was held in Cairo University Hospital on 12 patients with traumatic femoral head fracture treated surgically by reduction and fixation, between November 2012 and June 2016. Results According to Matta reduction criteria, 11 cases had anatomical reduction, one case with imperfect reduction, according to Matta radiographic criteria at follow-up, four cases with excellent score, five cases with good score, three cases with poor score, according to Merle d’ Aubigne and Postel criteria, four cases with excellent score, five cases with good score, one case with fair score, and two cases with poor score. Conclusion Surgical hip dislocation allows inspection of the entire femoral head and the full circumference of the acetabulum for rigid fixation and debridement, with low incidence of avascular necrosis, while anterior Heuter approach to the hip joint is a simple, adequate, muscle-preserving, and viable option for open reduction and internal fixation of femoral head fractures with early rehabilitation.

Internal Fixation With Absorbable Rods for the Treatment of Displaced Radial Neck Fractures in Children.

The treatment of radial neck fractures with complete displacement or severe displacement and an angle of >30 degrees is controversial. The currently used methods, including the Metaizeau technique, are associated with drawbacks such as imperfect reduction, epiphyseal damage, and delayed functional recovery. To overcome these drawbacks, we used absorbable rod fixation followed by early functional training for the treatment of displaced radial neck fractures in children. In this study, 68 patients (age, 4 to 12 y; average, 8.4 y; average angle, 58 degrees; average displacement, 53%) with radial neck fractures with Salter-Harris grades II to IV underwent lateral elbow open reduction and absorbable rod fixation. At 3 weeks postoperatively, the patients' plaster casts were removed, and functional training was started. Anatomic reduction was achieved in all patients. We followed-up 68 patients for 6 months to 4 years (average, 41 mo). No cases of radial nerve injury, radial bone necrosis, myositis ossificans, and postoperative infection were observed. The functional recovery was "excellent" in 43 patients, "good" in 13 patients, "average" in 12 patients, and "bad" in 0 patients, according to the Morrey evaluation standard. Open reduction with absorbable rod fixation for the treatment of displaced radial neck fractures in children was feasible and was a choice in children. Therapeutic II.

Outcome of alternative approach to displaced acetabular fractures

IntroductionAnatomical reduction of displaced acetabular fracture is not without its’ limitations and complications. This study is conducted to assess clinical and radiological outcomes as well as complications of treating displaced acetabular fractures with emphasis on anatomical reduction in weight-bearing area, mainly the posterior column, and imperfect reduction of the anterior column is acceptable. However, stability of both columns is mandatory. MethodsIt was a retrospective study carried out in a Level 1 arthroplasty and trauma centre. 23 patients (17 males, 6 females) with average age of 50.1 years (range, 36–68 years) with displaced acetabular fracture treated with combined incisions and plate-cable systems were included. There were 3 elementary and 18 associated fractures according to Letournel classification. Average follow-up was 23.5 months (range, 12–38.7 months). Mean operation time was 160min (range: 75–320min). Functional scores were evaluated using Harris Hip Score (HHS) whilst reduction was assessed by Matta criteria. Any displacement of reduction, osteoarthritis, heterotopic ossification, and other complications was recorded. Result65.2% (15/23) of the patients obtained excellent HHS and 21.7% (5/23) had good HHS. There were 12 anatomical, 6 imperfect, and 5 poor reductions. No displacement was recorded in final follow-up. Complications documented: three lateral femoral cutaneous nerve injuries, two conversions to total hip arthroplasty, three Brooker stage 1 heterotrophic ossification, one pulmonary embolism and one screw irritation. No incidence of wound breakdown, infection and radiological osteoarthritis was reported. ConclusionsImperfect reduction of the anterior column provided clinical outcomes that are as good as total anatomical reduction. This approach minimizes soft tissue damage and reduces perioperative morbidities.

Proximal Humeral Fractures: Is Some Varus Acceptable? Commentary on an article by Marc Schnetzke, MD, et al.: "Quality of Reduction Influences Outcome After Locked-Plate Fixation of Proximal Humeral Type-C Fractures".

While the overwhelming majority of proximal humeral fractures do well after nonoperative treatment, considerable clinical uncertainty remains, despite numerous techniques and studies, as to the best management of those with more complex fracture patterns. Further, when open reduction and internal fixation (ORIF)1 is elected, debate has raged as to how important anatomical reduction is to the final outcome, given that more aggressive exposure and fracture manipulation may cause soft-tissue damage and threaten bone vascularity. The current study is a welcome contribution to this conversation. This case series evaluated 98 consecutive type-C (OTA/AO classification) fractures treated by locking-plate ORIF at a single center. Surgeons exercised individual judgment as to whether to accept imperfect reduction rather than employ “harsh maneuvers of …

The added value of intraoperative CT scanner and screw navigation in displaced posterior wall acetabular fracture with articular impaction

Posterior wall with transverse acetabular fractures represents the most common type of acetabular fractures and is generally associated with poorer outcomes. This is caused by improper visualization of the fragments leading to imperfect reductions. Navigation in pelvic and acetabular trauma is reserved nowadays to non-displaced or mildly displaced fractures. To add to that, perioperative control of reduction is difficult using the conventional X-ray. The described 3D imaging method allowed proper reduction control. On the other hand, screw navigation of acetabular screws enabled better control of screw position as well as screw placement in otherwise inaccessible zones. In conclusion, peroperative 3D imaging and screw navigation optimize fracture reduction promoting better radiological and functional results.

Achieving Anatomic Acetabular Fracture Reduction-When is the Best Time to Operate?

We hypothesize that earlier operative intervention for acetabular fractures improves the probability of achieving an anatomic reduction. Retrospective review. Academic level I trauma center. Six hundred fifty acetabular fractures treated through open reduction and internal fixation (ORIF) between September 2001 and February 2014. Acetabular fracture ORIF. Reduction quality was assessed through postoperative radiographs. Displacement of ≤1 mm was considered an anatomic reduction, 2-3 mm imperfect, and >3 mm poor. Anatomic reductions were observed in 85% (n = 553) of cases, imperfect reductions in 11% (n = 74) of cases, and poor reductions in 4% (n = 23) of cases. Patients with anatomic reductions had significantly shorter times from injury to ORIF [odds ratio (OR) interval] (median, 3 d) when compared with either imperfect (median, 4.5 days, P = 0.02) or poor reductions (median, 7 days, P < 0.001) reductions. The OR interval of imperfect reductions was also significantly shorter than that of poor reductions (P = 0.02). Logistic regression analysis demonstrated that OR interval had an effect of -0.12, meaning that the log odds of anatomic reduction decreases by 0.12 with each day from injury to ORIF. The interval from injury to operative fixation of acetabular fractures affects reduction quality. Earlier intervention improves the probability of achieving an anatomic reduction; therefore, ORIF should be performed as early as possible, provided the patient is optimized for surgery. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures.

The goal of this study was to evaluate the safety and efficacy of a new technique for posterior column fixation through the standard ilioinguinal approach. We conducted a retrospective review involving 33 consecutive patients with complex acetabular fractures treated using a short buttress plate fixation of posterior column through single ilioinguinal approach. Radiographic evaluation was performed using criteria described by Matta. Functional outcome was assessed using modified Postel Merle D'Aubigné score. Between 2008 and 2013, 33 adult patients with mean age of 46years and mean follow up of 37.5months were enrolled. Anatomic reduction was obtained in 61% of cases, imperfect reduction in 24% of cases and poor reduction in 15% of cases. The average modified Merle d'Aubigné score was 15: categorized as excellent in seven, good in 18, fair in three, and poor in four. One patient died at 15days because of pulmonary embolism. Four patients sustained temporary lateral femoral cutaneous palsy. At final follow up, two patients had severe post-traumatic arthritis; one of them underwent a total hip arthroplasty at 93months. None of the patients had loss of reduction. A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures is a safe and effective method.