Minimal-invasive posterior approach in the treatment of the posterior wall fractures of the acetabulum.

We examined patients affected by a posterior wall fracture of the acetabulum treated with a minimally invasive posterior approach (from 12 to 18 cm). During 2004-2006 19 patients were treated by this approach. 4 patients had a combined surgery by the ileo-inguinal approach. Fracture fixation was performed using reconstruction plates and screws. All the patients were studied with typical X-rays projection for pelvis and iliac oblique view and obturator oblique view (Judet view) and CT scan with 3D reconstruction. After 3 months a CT scan was performed on about 30% of our patients, which demonstrated the perfect healing of the fractures. The most important advantages we observed using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early post-operative rehabilitation we examined the trophism of the gluteus maximus, which was found to be better than in patients treated with the typical Kocher-Langenbeck approach. The only absolute contraindication for this technique is in obese patients. The post-operative complications include one case of heterotypic ossification of the gluteus minimus and one case of peroneal-nerve palsy with the spontaneous and complete recovery within 6 months. According to our experience this kind of approach could be used for posterior wall fracture of the pelvis and it can be extended to transverse fractures. In the post-operative period the greatest advantage is the lesser muscle damage and therefore a most effective rehabilitation.