Posterior wall fractures of the acetabulum: characteristics, management, prognosis.
A consecutive series of 60 fractures of the posterior wall of the acetabulum, treated operatively in a Level I Trauma center, is reviewed retrospectively. Characteristics of the lesion, type of treatment, early and late postoperative complications and two-year functional results were recorded. In 27 patients (45%), additional damage to the cartilage of the acetabular cavity such as subchondral impaction, free articular fragments or separation of the posterior wall into several pieces was present. Seven patients (11.6%) showed preoperative neurological deficit. All fractures were treated with open reduction and internal fixation through a Kocher-Langenbeck approach. Secondary nerve damage was present in 8.3%. Early secondary surgery was necessary in 8.3%. During the first two years, additional surgery was performed in 7 patients (15.2%). The rate of periarticular ossifications was 26.1%. The rate of excellent and good results was 69.5%. The posterior wall fracture of the acetabulum is a more complex injury than generally is accepted. A large variety of articular lesions with varying degree of complexity is collected in this fracture type. Even in experienced hands, excellent and good long-term results will not exceed 75%. Poor results are due to suboptimal reconstruction of the posterior wall, partial osteonecrosis and/or complications of the Kocher-Langenbeck approach.
Rommens
P M
PM
Department of Trauma Surgery, University Hospitals of the Johannes Gutenberg-University, Mainz, Germany. rommens@unfall.klinik.uni-mainz.de
Giménez
M V
MV
Hessmann
M
M
D000077:Acetabulum / Q000293:injuries* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002358:Cartilage, Articular / Q000293:injuries; D005260:Female; D005593:Fracture Fixation, Internal; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies