title: Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial.
abstract: Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration.
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: G-Yves
authors.initials: GY
authors.lastname: Laflamme
authors.affiliation: Division of Orthopaedic Surgery, CHUQ-Hotel Dieu de Quebec, Québec, Canada.
authors.forename: Etienne L
authors.initials: EL
authors.lastname: Belzile
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Fernandes
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Maisonneuve-Rosemont Hospital, Montreal, Québec City, Canada.
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Vendittoli
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Jonah
authors.initials: J
authors.lastname: Hébert-Davies
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies
keywords: acetabulum fractures; acetabulum revision; pelvic discontinuity; periprosthetic fractures; posterior column