title: Bone graft from greater trochanter in posterior wall fractures with impacted fragments.
abstract: BACKGROUND
  Posterior wall fracture is the most common acetabular fracture. Comminuted fractures with an impacted segment represent a subtype of this injury. The subchondral bone of the articular zone is compressed and causes a bone defect. The impacted fragment should be isolated, mobilized, and then reduced. A bone graft should be used to fill the gap. The other fragments are fixed following the reduction of the impacted segment.
  
  
  METHODS
  Ten patients with comminuted fractures and impacted segments with bone defects were enrolled in our study, from January 2010 to July 2012. Autogenous bone grafts from the greater trochanter were used to fill the gap in all patients. The reduction was achieved through the insertion of the graft above the impacted fracture, and plate fixation was performed subsequently. Merle d'Aubigne and Postel scoring, modified by Matta, was applied to evaluate the patients during follow-up. The mean follow-up was 12 months.
  
  
  RESULTS
  The clinical results included one "excellent", four "very good", four "good" and one "poor". Pain in the zone of graft harvesting was not detected in any patient. Femoral head necrosis was observed in one case. No other severe complications were detected.
  
  
  CONCLUSIONS
  Using an autogenous bone graft to fill the bone defect supplies excellent mechanical stability without any severe complications at the donor site. This surgical technique seems to be effective and safe in treating a comminuted fracture of the posterior wall in association with an impacted segment.
  
  
  METHODS
  Level IV.
authors.affiliation: Orthopedic and Traumatology Department, Riuniti Hospital, Ancona, Italy, raffaele.pascarella@libero.it.
authors.forename: R
authors.initials: R
authors.lastname: Pascarella
authors.forename: M
authors.initials: M
authors.lastname: Commessatti
authors.forename: R
authors.initials: R
authors.lastname: Politano
authors.forename: A
authors.initials: A
authors.lastname: Maresca
authors.forename: M
authors.initials: M
authors.lastname: Del Torto
authors.forename: M
authors.initials: M
authors.lastname: Chehrassan
authors.forename: R
authors.initials: R
authors.lastname: Fantasia
mesh_terms: D000077:Acetabulum / Q000293:injuries*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016025:Bone Transplantation; D005260:Female; D005269:Femur / Q000637:transplantation*; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D018460:Fractures, Comminuted / Q000150:complications / Q000601:surgery*; D006617:Hip Dislocation / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome