Evaluation and Management of Posterior Wall Acetabulum Fractures

Perdue, Paul; Tainter, David M.; Toney, Clarence Brian; Lee, Christopher

doi:10.5435/jaaos-d-20-01301

Cited by 14 publications

(16 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The KL approach was obviously performed for the PWs in PC+PW, T+PW, and TV+PW. Furthermore, the intra-articular fragments and marginal impaction must be identified carefully and stabilized appropriately because these are the known factors affecting clinical outcomes [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Morphological Characteristics of the Posterior Wall Associated with Complex Acetabular Fractures: A Radiological Study Using 3D Software and Fracture Mapping Technique

Tian

Liang

Wang

et al. 2022

BioMed Research International

View full text Add to dashboard Cite

Background. The aim of the study was to compare the morphological distinctions of the posterior wall (PW) in different complex acetabular fractures using 3D software and fracture mapping technique and ultimately to provide for improved clinical treatment. Methods. One hundred and fourteen patients with complex acetabular fracture associated with PW were recruited. All patients were divided into two groups according to the injury mechanism of the PW: Group A (both-column and PW) and Group B (including posterior column and PW; T shape and PW; and transverse and PW). Fracture mapping was generated on the intra- and extrasurface of a standard template. The radiological parameters including spatial displacement, articular surface area, articular range, marginal impaction, and multifragments of the two groups were compared. Results. The spatial displacement, intra-/extra-articular surface area, and start and end point in Group A were 10.9 mm (IQR, 8.4-15.2), 8.2 ± 2.6 cm2, 17.9 ± 5.3 cm2, 0.8° (IQR, -6.0-16.2), and 107.5° (IQR, 97.2-116.9), respectively. The results in Group B were 30.4 mm (IQR, 16.8-48.7), 4.1 ± 2.0 cm2, 10.6 ± 4.4 cm2, 29.5° (IQR, 19.2-38.0), and 117.5° (IQR, 98.2-127.2), respectively. Marginal impaction was defined by Letournel et al. All the differences between two groups were significant ( P < 0.05 ). The fracture map in Group A showed an “L”-shaped pattern and a “cusp” on the ilium, and the PW was located at 1/5 to 1/4 of the posterosuperior part of the acetabulum. The fracture maps in Group B were scattered and lacked consistency, and the PWs were confined to 1/10 to 1/8 of the posterior acetabulum. Conclusions. Quantitative measurements and fracture mapping represented the differences in morphological characteristics of PWs associated with complex acetabular fractures.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Fractures of the posterior wall (PW) are the most common types of the acetabulum [ 1 , 2 ]. It has been reported that the PW fractures may be isolated or associated with other acetabular injuries, including posterior column, T shape, transverse, and both-column fractures [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Morphological Characteristics of the Posterior Wall Associated with Complex Acetabular Fractures: A Radiological Study Using 3D Software and Fracture Mapping Technique

Tian

Liang

Wang

et al. 2022

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…The main indication for fixation of the PW fragment is hip instability 1,4,25 . The anterior displacement tendency of the PW and femoral head were eliminated for the block of fixed main fragments.…”

Section: Discussionmentioning

confidence: 99%

Is Plating Fixation Through the Kocher–Langenbeck Approach for Associated Posterior Wall Fragment Indispensable in Both‐Column Acetabular Fractures?

Tian

Zhang

Liang

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective The treatment methods for posterior wall (PW) in both‐column acetabular fractures are controversial. The purpose of this study was to compare reduction quality, clinical outcomes, and complications of nonfixation for posterior wall fragment and plating via the Kocher–Langenbeck (KL) approach after anterior surgical procedures in both‐column acetabular fractures. Methods Forty‐nine patients with both‐column acetabular fractures associated with PW fixed via iliac fossa and Stoppa approaches from October 2012 to October 2017 were recruited into this study and were divided into two groups: Nonfix group (nonfixation for PW) and KL group (PW plating through the KL approach). Operation duration, intraoperative blood loss, reduction quality, fracture healing, and relevant complications of patients were reviewed. Merle d'Aubigné scores were used for assessing functional outcome. Results The mean blood loss and operation durations were lower in Nonfix group than in KL group (both p < 0.05). The mean hospital stay durations were (18.54 ± 6.42) days and (21.17 ± 7.32) days in groups Nonfix and KL, respectively (p = 0.186). All fractures healed well with no significant difference in union time between the two groups (p = 0.210). The rates of satisfactory reduction were 84.62% (22/26) in Nonfix group and 86.96% (20/23) in KL group (p = 1.000). The mean Merle d'Aubigné scores were 15.62 ± 2.28 in Nonfix group and 16.17 ± 2.19 in KL group (p = 0.388). The complication rates were 7.69% (2/26) in Nonfix group and 34.78% (8/23) in KL group (p = 0.046). Conclusions For both‐column acetabular fractures associated with PW fragment, although fixation of PW was not performed after anterior surgical procedures, satisfactory outcomes could also be obtained. However, nonfixation was a less invasive choice with a lower complication rate.

show abstract

“…Extensive fracture comminution makes it difficult to achieve anatomical reduction and is more likely to lead to poor clinical results [ 13 ]. We excluded PWFs without radiographic anatomical reduction and focused on the significance of the area where the fracture was comminuted.…”

Section: Discussionmentioning

confidence: 99%

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Lin

Liu

et al. 2022

JCM

View full text Add to dashboard Cite

Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes.

show abstract

Evaluation and Management of Posterior Wall Acetabulum Fractures

Cited by 14 publications

References 53 publications

Morphological Characteristics of the Posterior Wall Associated with Complex Acetabular Fractures: A Radiological Study Using 3D Software and Fracture Mapping Technique

Morphological Characteristics of the Posterior Wall Associated with Complex Acetabular Fractures: A Radiological Study Using 3D Software and Fracture Mapping Technique

Is Plating Fixation Through the Kocher–Langenbeck Approach for Associated Posterior Wall Fragment Indispensable in Both‐Column Acetabular Fractures?

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Contact Info

Product

Resources

About