Posterior wall fractures
The goal of surgical treatment of posterior wall fractures is to obtain stability of the hip by restoring the normal shape of the acetabulum and to restore the normal pressure distribution within the joint by anatomic reduction of the articular surface. Fractures of the posterior wall are the most common type of acetabular fracture and account for approximately one quarter of all acetabular fractures. These fractures typically occur in young patients as a result of a high-energy trauma, such as motor vehicle collisions. Displaced posterior wall fractures create an incongruity in the articular surface and, in some cases, result in instability of the hip. Diagnosis is made on the anteroposterior pelvis, obturator oblique, and iliac oblique radiographs of the pelvis. Computed tomography (CT) is helpful for identifying subtle marginal impaction and osteochondral fragments. Indications for operative treatment include instability of the hip, marginal impaction, and retained osteochondral fragments. Relative indications include articular fractures that encompass more than 33% of the wall width and minimally displaced fractures that are part of the more complex fracture pattern that require an ilioinguinal approach. Surgical reduction is performed through a Kocher-Langenbeck incision in the prone position with the knee bent to relax the sciatic nerve. Three and one-half mm implants are used for fixation of posterior wall fractures. Good to excellent results can be obtained in up to 80% of fractures that have been anatomically reduced and rigidly fixed. Anatomic reduction is a highly significant predictor of an excellent or a good result. Complications include wound infection, iatrogenic nerve palsy, heterotopic ossification, and thromboembolic complications. Posttraumatic arthritis is the most common late complication that can occur. Copyright © 1999 by W.B. Saunders Company.
Olson, SA; Finkemeier, CG
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