Background: Posterior wall injuries represent the commonest type of acetabular fractures, it could be isolated fractures or - more commonly - associated with hip dislocation with varying degrees of displacement and comminution. Being intra articular injuries affecting the congruency and stability of the hip joint, 30% of patients with such injuries have poor outcomes. Accurate fracture reduction with stable fixation is the standard way for achieving satisfactory results. This study aims to evaluate the suitability and efficacy - in light of the clinical and radiological results - of using only screws for fixation of certain posterior wall fractures through a limited exposure using the Kocher-Langenbeck approach.
Patients and Methods: This study included 16 cases of displaced posterior wall fractures with single, sizable fragment or multiple, non comminuted fragments treated with open reduction and internal fixation using only screws through a limited exposure using the Kocher-Langenbeck approach. In 14 cases, fractures were associated with hip dislocation while the last 2 cases had isolated posterior wall injuries. Radiological assessment according to Matta and Heeg criteria and clinical evaluation according to Postel score were done post-operatively and throughout the follow-up period that extended for a mean duration of 18.9 ± 6.7 months.
Results: Clinically, satisfactory results (excellent and good) were reported in 14 cases representing 87.5 % of the studied cases. 1 case was rated fair and 1 case was rated poor, so unsatisfactory results (fair and poor) were reported in 2 cases representing 12.5 % of the studied cases. According to the modified criteria of Matta, 12 cases had excellent reduction, 4 cases had good reduction and according to the radiographic grading criteria by Heeg, 14 cases were excellent with a normal appearing hip joint compared to the healthy side, 1 case was fair with joint narrowing less than 50 % compared to the other healthy side with no osteophytes and viable head, 1 case was rated as poor with advanced degenerative changes, head subluxation and severe avascular necrosis. No cases developed heterotopic ossification or implant failure.
Conclusions: Fixation by only screws through a limited exposure could be a simple and reliable fixation method for certain posterior wall fractures with less soft tissue dissection, intra-operative and post-operative complications with comparable clinical and radiological results to the more complex fixation methods using conventional reconstruction plates or locked plates. |
