Management of the posterior wall fracture in associated both column fractures of the acetabulum

Chen, Michael; Hollyer, Ian; Wadhwa, Harsh; Tigchelaar, Seth; Rysselberghe, Noelle L Van; Bishop, Julius A.; Bellino, Michael J.; Gardner, Michael J.

doi:10.1007/s00590-020-02850-9

Cited by 8 publications

(14 citation statements)

References 18 publications

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“…In contrast, the injury mechanism of PW fracture in both-column fractures is created by a “pull-type” mechanism and often a large-sized fragment [ 3 , 6 ]. Although the differences between the two types of PW fractures have been reported in recent literature [ 3 , 7 , 8 ], to our knowledge, there are no quantitative morphological comparisons of two kinds of PW associated with complex acetabular fractures.…”

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

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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.

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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

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“…Moreover, the PW fragment can also be indirectly reduced with the traction of the uninjured capsule and the surrounding soft tissues after the femoral head reduction 3 . Chen et al 11 . also demonstrated that the clinical outcomes were similar regardless of whether or not the PW associated with both‐column fractures was reduced and stabilized.…”

Section: Discussionmentioning

confidence: 99%

“…According to the previous literature, both-column acetabular fractures are also commonly associated with PW fracture 9 . Moreover, unlike the PW mentioned above 10,11 , the PW detachment in both-column fractures can be caused by an anterior "pull-type" force of the hip joint capsule and the PW fragments are often undisplaced or minimally displaced 3,12 . In the past decade, the idea that main fragments of both-column fractures can be managed through a single anterior approach has been accepted by most surgeons 13,14 .…”

Section: Introductionmentioning

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

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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.

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“…Several studies have suggested that some of these fractures may be treated nonoperatively without affecting the patient's functional outcome. 3,5 Other studies have suggested that certain PW fragments may benefit from the use of percutaneous reduction and fixation after the use of anterior approach to address the ABC component of the ABC-PW. 3,4,6 The reality depends on the morphology of the PW fragment and how much of the weight-bearing dome it involves.…”

Section: Discussionmentioning

confidence: 99%

Defining Posterior Wall Fragments in Associated Both Column Acetabular Fractures (OTA/AO 62C)

Arthur¹,

Novak

Unno

et al. 2023

Journal of Orthopaedic Trauma

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Objective: Associated both column acetabular fractures (OTA/AO 62C) with concomitant posterior wall fracture fragments (ABC + PW) have not been well-defined. The purpose of this study was to report on the incidence and morphology of ABC + PW fractures. Methods: A retrospective review of associated both column (ABC) fractures between 2014 and 2020 was performed. Computed tomography scans including 3-D surface rendered reformats for each were reviewed to determine whether a posterior wall (PW) fragment was present and its morphologic characteristics. Results: One hundred fifty-two ABC fractures were identified. Sixty-two fractures (41%) were identified as ABC + PW. 3D-computed tomographies were available on 58 fractures. Morphologic analysis was performed based on the relationship of the fracture to the gluteal pillar. Twenty PW fragments were posterior to the gluteal pillar, 19 extended into the gluteal pillar, and 19 extended anterior. Fifty-two fractures were treated with operative fixation; 32 (62%) were clamped and fixed with screws from the same anterior approach whereas 15 (29%) required a separate posterior approach; and no fixation was placed in 5 (9%). 29 of 32 PW fragments (91%) requiring fixation that extended into or anterior to the pillar were fixed from the anterior approach, and 7 of 15 posterior fractures (47%) required a separate posterior approach. Conclusions: A separate PW fragment was identified in 41% of ABC fractures. Their variation in morphology can be classified into 3 types based on the relation to the gluteal pillar that has potential implications for treatment from the anterior approach compared with requiring a separate posterior approach. We suggest these data could be used to update the 2018 OTA/AO Fracture Compendium. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Management of the posterior wall fracture in associated both column fractures of the acetabulum

Cited by 8 publications

References 18 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?

Defining Posterior Wall Fragments in Associated Both Column Acetabular Fractures (OTA/AO 62C)

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