Title

Surgical repair of posterior-wall/column acetabular fractures: Surgical approaches and results

Document Type

Conference Proceeding

Publication Date

2-1-2006

Journal

Current Opinion in Orthopaedics

Volume

17

Issue

1

DOI

10.1097/01.bco.0000192520.48411.fa

Keywords

Acetabular fracture; Posterior-wall fracture; Surgical technique

Abstract

Purpose of review: Posterior-wall acetabular fractures are common injuries associated with high-energy trauma. Owing to the relative familiarity of orthopedic surgeons with the posterior hip anatomy, these fractures are sometimes treated by surgeons other than traumatologists. To ensure good functional outcomes, however, the intricacies of the surgical approach, reduction, fixation of these fractures and potential complications must be mastered. Recent findings: The treatment of posterior acetabular fractures begins upon patient presentation. The patient must first be evaluated with a complete physical assessment, specifically noting the function of the sciatic nerve, and then the fracture must be evaluated with high-quality radiographs. Once the fracture is understood, preoperative planning is critical to ensure the best functional outcome. Meticulous surgical technique is imperative for the repair of these fractures, to avoid iatrogenitic femoral head avascular necrosis, and sciatic nerve injury, and to avoid malreduced fracture fragments. Finally, fragment fixation must be appropriate to ensure the fracture reduction is maintained. Summary: Although outcome studies of posterior acetabular fractures have shown a good outcome can be achieved in greater than 80% of cases, there are a number of complications that must be avoided. The eventual outcome of these fractures has been shown to be correlated with patient age, fracture pattern, and the presence of associated injuries. Additionally, factors such as fracture reduction and avoidance of iatrogenic injury have also been shown to influence outcome and are directly controlled by the operative surgeon. © 2006 Lippincott Williams & Wilkins.

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