title: Long term results after surgical management of posterior wall acetabular fractures.
abstract: BACKGROUND
  Posterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome.
  
  
  METHODS
  We retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25-60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5-22 years) who met the inclusion criteria formed the study cohort. Matta's criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d'Aubigné and Postel score.
  
  
  RESULTS
  Anatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d'Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery.
  
  
  CONCLUSIONS
  Anatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures.
  
  
  METHODS
  (Level 4) Retrospective case series.
authors.affiliation: Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J (UH) Medical Enclave, Rohtak, Haryana, 24001, India.
authors.forename: Narender Kumar
authors.initials: NK
authors.lastname: Magu
authors.forename: Paritosh
authors.initials: P
authors.lastname: Gogna
authors.forename: Amanpreet
authors.initials: A
authors.lastname: Singh
authors.forename: Rohit
authors.initials: R
authors.lastname: Singla
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rohilla
authors.forename: Amit
authors.initials: A
authors.lastname: Batra
authors.forename: Reetadyuti
authors.initials: R
authors.lastname: Mukhopadhyay
mesh_terms: D000077:Acetabulum / Q000293:injuries*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome