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Management of the posterior wall fracture in associated both column fractures of the acetabulum

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The primary aim of this study was to compare clinical outcomes in patients with associated both column (ABC) acetabular fractures with fracture of the posterior wall (PW), in which the PW underwent reduction and fragment-specific fixation versus those that were treated with column fixation alone. Secondary aims were to assess PW fracture incidence and morphology, as well as to compare radiographic outcomes including fracture healing and interval displacement of the PW in those that did and did not undergo fragment-specific fixation of the PW.

Methods

This was a retrospective series of ABC acetabular fractures treated at a single Level I trauma center. Separate fractures of the PW were identified, and associated features were assessed. Associated both column fractures that underwent reduction and fragment-specific fixation of the PW where then compared to ABC fractures with PW involvement that underwent column reconstruction alone. Radiographic and clinical outcomes were compared.

Results

Fractures of the PW occurred in 55.7% of ABC fractures and were associated with central displacement of the femoral head. The majority of PW fractures were large and involved the acetabular roof. All PW fractures healed without displacement by 3 months, regardless of whether or not reduction and stabilization was performed. Mid-term outcomes at 1-year were similar regardless of whether or not the PW was reduced and stabilized, with regards to Tönnis grade, Merle d'Aubigné-Postel score, and conversion to total hip arthroplasty.

Conclusion

Reduction and fragment-specific fixation of the PW component of ABC acetabular fractures did not improve outcomes in this small comparative study. Posterior wall fractures associated with ABC patterns are frequently large-sized fragments that involve the acetabular roof and are rendered stable after reconstruction of the columns.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA

    Michael J. Chen, Ian Hollyer, Harsh Wadhwa, Seth S. Tigchelaar, Noelle L. Van Rysselberghe, Julius A. Bishop, Michael J. Bellino & Michael J. Gardner

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  1. Michael J. Chen
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  2. Ian Hollyer
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  3. Harsh Wadhwa
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  4. Seth S. Tigchelaar
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  5. Noelle L. Van Rysselberghe
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  6. Julius A. Bishop
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  7. Michael J. Bellino
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  8. Michael J. Gardner
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Corresponding author

Correspondence to Michael J. Chen.

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Conflict of interest

M.J.G. receives personal fees from Pacira Pharmaceuticals, Biocomposites, BoneSupport AB, Conventus, Globus Medical, StabilizOrtho, Synthes, and from KCI outside of the submitted work. J.A.B. receives personal fees from Globus Medical and Innomed outside of the submitted work. None of the remaining authors has anything to disclose.

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This article contained only de-identified human participant information and was approved by an institutional review board.

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Chen, M.J., Hollyer, I., Wadhwa, H. et al. Management of the posterior wall fracture in associated both column fractures of the acetabulum. Eur J Orthop Surg Traumatol 31, 1047–1054 (2021). https://doi.org/10.1007/s00590-020-02850-9

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  • DOI: https://doi.org/10.1007/s00590-020-02850-9

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