Mohamed Abo-Elsoud1, Elsayed Kassem2. 1. Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt. m.soud@kasralainy.edu.eg. 2. Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
Abstract
PURPOSE: Fractures of the posterior wall (PW) of the acetabulum have a wide variety of patterns; treating them as a single entity using the standard ilio-ischial plate would be inappropriate. We are presenting our experience with a fragment-specific fixation technique in which each PW fragment is reduced and fixed with separate buttress/anti-glide plate(s) in a tailored fashion, abandoning the use of the ilio-ischial plate. PATIENTS AND METHODS: Fragment-specific fixation was applied to 46 patients with PW fractures (33 simple and 13 associated fracture types) with a mean follow-up of 34.9 ± 20.5 months (range: 12-72). Kocher-Langenbeck approach was utilized for all patients with dissection limited to the fracture site (a limited form of the approach was used in three patients). RESULTS: Anatomical reduction of the fracture was achieved in 41 (89.1%) patients, imperfect reduction in four (8.7%), and poor reduction in one (2.2%) patient. Excellent to good radiological and functional results were achieved in 91.3% of cases. A single case had recurrent subluxation which was related to avascular necrosis of the highly comminuted wall fragments. Four patients developed post-traumatic arthritis and required total hip arthroplasty. None of our cases developed clinically significant heterotopic bone formation. CONCLUSION: With a versatile yet a strong-enough construct and limited soft tissue dissection, fragment-specific fixation yielded very good results with few complications.
PURPOSE: Fractures of the posterior wall (PW) of the acetabulum have a wide variety of patterns; treating them as a single entity using the standard ilio-ischial plate would be inappropriate. We are presenting our experience with a fragment-specific fixation technique in which each PW fragment is reduced and fixed with separate buttress/anti-glide plate(s) in a tailored fashion, abandoning the use of the ilio-ischial plate. PATIENTS AND METHODS: Fragment-specific fixation was applied to 46 patients with PW fractures (33 simple and 13 associated fracture types) with a mean follow-up of 34.9 ± 20.5 months (range: 12-72). Kocher-Langenbeck approach was utilized for all patients with dissection limited to the fracture site (a limited form of the approach was used in three patients). RESULTS: Anatomical reduction of the fracture was achieved in 41 (89.1%) patients, imperfect reduction in four (8.7%), and poor reduction in one (2.2%) patient. Excellent to good radiological and functional results were achieved in 91.3% of cases. A single case had recurrent subluxation which was related to avascular necrosis of the highly comminuted wall fragments. Four patients developed post-traumatic arthritis and required total hip arthroplasty. None of our cases developed clinically significant heterotopic bone formation. CONCLUSION: With a versatile yet a strong-enough construct and limited soft tissue dissection, fragment-specific fixation yielded very good results with few complications.