Posterior Wall Acetabular Fractures Research Articles

Management of Acetabular Fracture

Acetabular fractures are relatively uncommon, but frequency is becoming increasingly with the increase of automobile accident. Undisplaced acetabular fractures have a good prognosis, but major displaced acetabular fractures have always given rise to difficulty and have a problem if fractures are not accurately evaluated, classified and reduced anatomically. The priciples of treatment are to restore the fractured acetabulm to its normal anatomy, to maintain and restore the function and accordingly early joint motion to promote healing and to prevent joint adhesion. However, the treatment of displaced fracture of acetabulum has been controversal. Judet, Pennal and Matta advocated open reduction and internal fixation for displaced fracture of acetavbulum. But, Watson Jones and Crenshaw reported that closed reduciton such as traction was used, good result could be obtained. The authors studied the sex and age distribution, classification according to roentgenographic findings, associated injuries, methods of treatment and prognosis among 67 patients who were admitted to the department of Orthopedic Sugery of Chonbuk National University Hospital under diagnosis of acetabular fracture and we evaluate the usefulness of spring plate for posterior wall fracture of acetabulum. 대한골절학회지 제12권, 제1호, 1 9 9 9년 1월 The Journal of the Korean Society of Fractures Vol.12, No.1, January, 1999

The effect of variable size posterior wall acetabular fractures on contact characteristics of the hip joint.

The indications for open reduction and internal fixation of posterior wall acetabular fractures associated with a clinically stable hip joint are unclear. In previous work a large posterior wall defect (27% articular surface area) resulted in significant alteration of load transmission across the hip; specifically, there was a transition from evenly distributed loading along the acetabular articular surface to loading concentrated mainly in the superior portion of the articular surface during simulated single leg stance. However, the majority of posterior wall fractures involve a smaller amount of the articular surface. Posterior wall acetabular fractures not associated with instability of the hip are commonly treated nonoperatively. This practice does not account for the size of the posterior wall fracture. To study the biomechanical consequences of variably sized articular defects, a laboratory experiment was conducted evaluating three progressively larger posterior wall defects of the acetabulum during simulated single leg stance using superlow Fuji prescale film (Itochu International, New York): (a) 1/3 articular surface width through a 50 degrees arc along the posterior wall of the acetabulum, (b) 2/3, and (c) 3/3 articular width defects through the same 50 degrees arc along the posterior wall of the acetabulum. In the intact acetabulum, 48% of the total articular contact was located in the superior acetabulum. Twenty-eight percent of articular contact was in the anterior wall region of the acetabulum and 24% in the posterior wall region. After the 1/3 width posterior wall defect, 64% of the articular contact was located in the superior acetabulum (p = 0.0011). The 2/3 width posterior wall defect resulted in 71% of articular contact area being located in the superior acetabulum (p = 0.0006). After the 3/3 width posterior wall defect, 77% of articular contact was located in the superior acetabulum, significantly greater than the intact condition (p < 0.0001) and 1/3 width defect (p = 0.0222). The total absolute contact areas for all defect conditions were significantly less than the intact conditions. The results of this study reconfirm the observation that posterior wall fractures of the acetabulum significantly alter the articular contact characteristics in the hip during single leg stance. The relationship between defect size and changes in joint contact showed that the smallest defect resulted in the greatest alteration in joint contact areas, whereas larger defects resulted in minor increments of change in contact area. This finding is of concern because the clinical practice of managing acetabular fractures nonoperatively if the hip joint is stable is based on the supposition that the joint retains enough integrity to function without undue risk of late posttraumatic osteoarthritis. A better understanding of the natural history of stable posterior wall acetabular fractures is needed to ascertain whether some of these fractures merit operative repair.

Surgical Treatment of the Posterior wall Fracture of Acetabulum with Posterior Hip Dislocation

Surgical Treatment of the Posterior wall Fracture of Acetabulum with Posterior Hip Dislocation

Traumatic Posterior Acetabular Defects Reconstructed With Iliac Crest Autograft

In two cases of posterior wall acetabular fracture, the fracture fragment was too comminuted to be fixed per primam. A full-thickness iliac crest autograft was used as initial reconstruction in these two cases. Although the reconstruction was not anatomic, one of the two patients is functioning with only minimum symptoms at five years. Incorporation of the autograft has been documented in both cases. Although the procedure may not accurately reproduce the anatomy of the hip joint, it will appropriately supplement viable acetabular bone structure.

Reconstruction of fractures of the posterior acetabular wall

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.

Posterior Acetabular Wall Fractures

Screw placement at the posterior margin of the acetabulum during open reduction and internal fixation of posterior acetabular wall fractures must avoid intraarticular penetration of the hip joint. Analysis of the preoperative computed tomography (CT) scan, operative positioning of the patient in a secure reference plane, and placement of the screws in the coronal plane perpendicular to the long axis of the body will help avoid this surgical complication.

Acetabular posterior wall fracture. 38 cases followed for 5 years.

Thirty-eight patients with a fracture of the posterior wall of the acetabulum were reviewed after 5 (2-12) years. Of 18 patients with successful manual reduction of a femoral head dislocation, a small fracture fragment, no sciatic nerve injury and who were not operated on, 17 had a good result. Of 20 patients who were operated on either because of the large size of the fracture fragment or because of a persistent dislocation of the femoral head, 6 had a poor result due to femoral head necrosis. In these 6 patients the reduction had been delayed and the acetabular osteochondral lesion was more severe than in the other patients. Skeletal traction seems unnecessary in the treatment of acetabular posterior wall fracture.