title: Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum.
abstract: Our aim was to evaluate the efficacy of a two-level reconstruction technique using subchondral miniscrews for the stabilisation of comminuted posterior-wall marginal acetabular fragments before applying lag screws and a buttress plate to the main overlying posterior fragment. Between 1995 and 2003, 29 consecutive patients with acute comminuted displaced posterior-wall fractures of the acetabulum were treated operatively using this technique. The quality of reduction measured from three standard plain radiographs was graded as anatomical in all 29 hips. The clinical outcome at a mean follow-up of 35 months (24 to 90) was considered to be excellent in five patients (17%), very good in 16 (55%), good in six (21%) and poor in two (7%). The use of the two-level reconstruction technique appears to provide stable fixation and is associated with favourable results in terms of the incidence of post-traumatic osteoarthritis and the clinical outcome. However, poor results may occur in patients over the age of 55 years.
authors.affiliation: Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK. pgiannoudi@aol.com
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
authors.forename: C
authors.initials: C
authors.lastname: Tzioupis
authors.forename: B R
authors.initials: BR
authors.lastname: Moed
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries*; D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D016138:Walking