Abstract
Background
This study aims to describe an uncommon presentation of posterior wall acetabular fracture–dislocation with displacement of fracture fragment anterior to femoral head with its management and clinico-radiological outcome.
Methods
This retrospective review was performed at a Level I trauma centre over a period of six years. Hospital records, radiological database, operative register and follow-up data identified 7 patients with anteriorly lying posterior wall fragment of acetabulum. Analysis was performed with 6 patients having complete follow-up ranging from 2 to 7 years. The patients were operated with standard Kocher-Langenbeck approach; modification of this approach with trochanteric flip osteotomy and safe surgical dislocation was performed based on the location of the anteriorly lying fragment. Final functional and radiographic outcome was analysed according to modified Merle D’Aubigné and Postel score, and Matta’s grade, respectively.
Results
This uncommon presentation was observed in 11.11% of patients out of 63 patients with isolated posterior wall acetabular fractures managed during the study period. Anteriorly displaced posterior wall fragment was located in anterosuperior (n, 3), anterocentral (n, 2) and anteroinferior (n, 1) quadrants anterior to the femoral head. Final clinical and radiographic outcome revealed good-to-excellent outcome in 5 (83.33%) patients, and poor in one. One patient developed progressive arthrosis of hip which required total hip arthroplasty within 2 years.
Conclusion
This unusual pattern of posterior wall fracture requires adequate pre-operative planning, careful handling of the fractured fragments along with its soft tissue attachments during surgery, and preferably a concomitant trochanteric flip osteotomy with/without surgical hip dislocation to achieve good results.
Similar content being viewed by others
References
Letournel E, Judet R (1993) Fractures of the acetabulum. Springer, Berlin Heidelberg New York
Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. J Bone Joint Surg Am 46:1615–1647
Baumgaertner MR (1999) Fractures of the posterior wall of the acetabulum. J Am Acad Orthop Surg 7(1):54–65
Moed BR, Kregor PJ, Reilly MC, Stover MD, Vrahas MS (2015) Current management of posterior wall fractures of the acetabulum. Instr Course Lect 64:139–159
Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78(11):1632–1645
Siebenrock KA, Gautier E, Ziran BH, Ganz R (1998) Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach. J Orthop Trauma 12(6):387–391
Ganz Rl, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83(8):1119–24
D’Aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36(A-3):451–475
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632
Saterbak AM, Marsh JL, Nepola JV, Brandser EA, Turbett T (2000) Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma 14(4):230–237
Moed BR, WillsonCarr SE, Watson JT (2002) Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am 84(5):752–758
Bhandari M, Matta J, Ferguson T, Matthys G (2006) Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip. J Bone Joint Surg Br 88(12):1618–1624
Mitsionis GI, Lykissas MG, Motsis E et al (2012) Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: a study with a minimum follow-up of 15 years. J Orthop Trauma 26(8):460–465
Magu NK, Gogna P, Singh A et al (2014) Long term results after surgical management of posterior wall acetabular fractures. J Orthop Traumatol 15(3):173–179
Pantazopoulos T, Nicolopoulos CS, Babis GC, Theodoropoulos T (1993) Surgical treatment of acetabular posterior wall fractures. Injury 24(5):319–323
Pascarella R, Maresca A, Reggiani LM, Boriani S (2009) Intra-articular fragments in acetabular fracture-dislocation. Orthopedics 32(6):402
Keel MJ, Bastian JD, Büchler L, Siebenrock KA (2010) Surgical dislocation of the hip for a locked traumatic posterior dislocation with associated femoral neck and acetabular fractures. J Bone Joint Surg Br 92(3):442–446
Beck M, Leunig M, Ellis T, Sledge JB, Ganz R (2003) The acetabular blood supply: implications for periacetabular osteotomies. Surg Radiol Anat 25(5–6):361–367
Berton R. Moed, Mark Reily. Acetabulum Fractures. In: Rockwood and Green's Fractures in Adults, 8th Edition. 2015 Lippincott Williams & Wilkins. Pg 1919–20, Pg 1933–24.
Sen RK, Tripathy SK, Aggarwal S, Tamuk T (2011) Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture. Int Orthop 35(8):1223–1228
Trikha V, Das S, Madegowda A, Agrawal P (2018) Midterm results of trochanteric flip osteotomy technique for management of fractures around the hip. Hip Int 28(2):148–155
Tannast M, Najibi S, Matta JM (2012) Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am 94(17):1559–1567
Masse A, Aprato A, Rollero L, Bersano A, Ganz R (2013) Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop Relat Res 471(12):4056–4064
Funding
No funding or grants were received or will be received from any commercial party relating to the subject of this article.
Author information
Authors and Affiliations
Contributions
All authors whose names appear on the submission VT made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data; or the creation of new software used in the work; SD drafted the work or revised it critically for important intellectual content; SM approved the version to be published; and BC agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in this study involving human participants were in accordance with the ethical standard of the institutional and/ international research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Trikha, V., Das, S., Mittal, S. et al. An unusual pattern of posterior wall fracture of acetabulum. Eur J Orthop Surg Traumatol 31, 643–650 (2021). https://doi.org/10.1007/s00590-020-02814-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-020-02814-z