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

Abstract

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.

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

“…Secondary congruency of the acetabulum and femoral head is a characteristic of acetabular both-column fractures in Group A, which means that the joint contact stress is evenly distributed over the entire articular surface [ 12 ]. And the displacement of PW in Group A disappeared following the reduction of the anterior column, quadrilateral plate, and femoral head [ 22 ]; this occurrence is known as a “congruency reduction.” However, after reduction of the main fragments (posterior column, T shape, and transverse) and femoral head in Group B, the visible displacement of the PW remained and required additional posterior fixation. It should be mentioned that displacements in this study were 3D distances, which were different from the measurements of the fracture gaps noted in radiographs or CT scans in other studies [ 23 ].…”

“…Additionally, the fracture map of Group A elucidated a “cusp” of the PW on the outer table of the ilium. The “cusp” of the PW, which can be regarded as an auxiliary marker for diagnosing BC+PW fractures, was often obvious in the obturator-oblique view and was named the “antispur” sign [ 22 ] ( Figure 8 ). In Group A, 76% fracture lines of PW extended upward toward the iliac crest and 24% oriented around the anterior superior spine anteriorly.…”

Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review

“…KL approach allows the direct visualization of the entire posterior column, posterior wall, and supra-acetabular region. Isolated posterior wall, isolated posterior column, associated posterior wall and column, and fractures with posterior wall/column fragment could be treated through the KL approach [ 35 , 36 ].…”

“…On the other hand, the limitations of a KL approach become apparent when dealing with isolated anterior wall/column fractures or when confronting associated fractures accompanied by anterior fragments. The intricacies of such fractures demand alternative strategies beyond the scope of a KL approach [ 35 , 36 ]. In the case of fracture involving the anterior column fragment, experts like Manson and Chen et al [ 37 , 38 ] propose a more comprehensive solution involving reduction and fixation through an anterior approach.…”

Effects of Different Surgical Procedures on the Therapeutic Effects, Prognosis, and Major Complications of Acetabular Fractures in the Elderly of China: A Systematic Review and Meta-Analysis

“…The hip joint is the largest and most important weight-bearing joint in the human body. The treatment of acetabular fractures is a great challenge for orthopedic surgeons due to the special anatomical position of the acetabulum, its irregular anatomical form, and changing fracture types [ 17 , 18 ]. With the average life expectancy of human beings having increased significantly, the proportion of the elderly population has greatly increased [ 19 ].…”