Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 6 , ISSUE 1 ( January-June, 2024 ) > List of Articles


Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum

Kingsly Paulraj, Muthu Sathish

Keywords : Acetabular fracture, Internal fixation, Kocher–Langenbeck approach, Posterosuperior fracture, Posterior wall

Citation Information : Paulraj K, Sathish M. Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum. 2024; 6 (1):74-78.

DOI: 10.5005/jojs-10079-1138

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Introduction: Posterior wall acetabular fractures remain a common entity with respect to fractures involving the acetabulum (35–47%) of which 3.76% of them involve the acetabular roof. Our study aims to identify the mechanism of injury of these injuries involving the roof of the acetabulum and the challenges in their management. Materials and methods: This is a prospective study between January 2018 and December 2022. All surgically treated adult patients with acetabular fractures involving the posterosuperior wall or the posterosuperior wall with a posterior column were included in the study. We excluded patients with posterior, posteroinferior acetabular fractures, anterior wall fractures, column fractures, and patients medically unfit for surgery. We used a horizontal reference line connecting the superior edge of the bilateral acetabulum to evaluate the adequacy of the buttressing effect by the plate. Weller classification was used in our study. Results: A total of 20 patients (M:F = 16:4) of mean age 36.4 (±12.6) years were enrolled for analysis. According to Waller's classification, seven patients were type I, 13 patients were type II fractures, and no type III fractures. The femoral head was found to be dislocated in 10 patients and subluxation in four patients. A total of 15 patients were stabilized using lag screws and neutralization reconstruction plate and the remaining five patients were fixed with reconstruction plate in buttress mode. The average reconstruction plate length used in our study was nine holes with a mean of four holes with two screws on an average placed in the reconstruction plate superior to the reference line. Conclusion: Posterosuperior acetabular fractures are more commonly seen than any other types of posterior wall fractures with the hip in low flexion during the impact. In treating such injuries, it is essential to preoperatively analyze the superior fracture extension. For adequate visualization and reduction of these fractures, the incision is placed a little super-anteriorly, and the hip is maintained in flexion and abduction during fracture reduction.

  1. Kreder HJ, Rozen N, Borkhoff CM, et al. Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall. J Bone Joint Surg Br 2006;88(6):776–782. DOI: 10.1302/0301-620X.88B6.17342
  2. Baumgaertner MR. Fractures of the posterior wall of the acetabulum. J Am Acad Orthop Surg 1999;7(1):54–65. DOI: 10.5435/00124635-199901000-00006
  3. Letournel E, Judet R. Fractures of the Acetabulum. New York: Springer; 1993.
  4. Matta JM. 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 1996 78(11):1632–1645. DOI: 10.1055/s-0030-1267077
  5. Waller A. Dorsal acetabular fractures of the hip. (dashboard fractures). Acta Chir Scand Suppl 1955;205:1–94.
  6. Berton C, Bachour F, Migaud H, et al. A new type of acetabular fracture: “true” posterosuperior fracture, a case report. Rev Chir Orthop Reparatrice Appar Mot 2007;93(1):93–97. DOI: 10.1016/s0035-1040(07)90210-x
  7. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction preliminary report. J Bone Joint Surg Am 1964;46:1615–1646. PMID: 14239854.
  8. Petsatodis G, Antonarakos P, Chalidis B, et al. Surgically treated acetabular fractures via a single posterior approach with a follow-up of 2-10 years. Injury 2007;38(3):334–343. DOI: 10.1016/j.injury.2006.09.017
  9. Keith JE Jr, Brashear HR Jr, Guilford WB. Stability of posterior fracture-dislocations of the hip. Quantitative assessment using computed tomography. J Bone Joint Surg Am 1988;70(5):711–714. PMID: 3392065.
  10. Olson SA, Matta JM. The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report). J Orthop Trauma 1993;7(5);402–413. DOI: 10.1097/00005131-199310000-00002
  11. Moed BR, Ajibade DA, Israel H. Computed tomography as a predictor of hip stability status in 276 posterior wall fractures of the acetabulum. J Orthop Trauma 2009;23(1):7–15. DOI: 10.1097/BOT.0b013e31818f9a5c
  12. Tang Y, Zhang YT, Zhang CC, et al. Anatomic measurements and quantitative analysis of posterior acetabular wall. Zhongguo Gu Shang 2014;27(12):1024–1028. PMID: 25638891.
  13. Zhang Y, Tang Y, Wang P, et al. Biomechanical comparison of different stabilization constructs for unstable posterior wall fractures of acetabulum. A cadaveric study. PLoS One 2013;8(12):e82993. DOI: 10.1371/journal.pone.0082993
  14. Zanna L, Ceri L, Scalici G, et al. Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty. Eur J Orthop Surg Traumatol 2023;33(6):2419–2426. DOI: 10.1007/s00590-022-03451-4
  15. Graulich T, Gräff P, Omar Pacha T, et al. Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation. Eur J Trauma Emerg Surg 2023;49(1):343–349. DOI: 10.1007/s00068-022-02072-0
  16. Firoozabadi R, Spitler C, Schlepp C, et al. Determining stability in posterior wall acetabular fractures. J Orthop Trauma 2015;29(10):465–469. DOI: 10.1097/BOT.0000000000000354
  17. Kiran M, Frostick R, Elnahal W, et al. The fate of acetabular fracture fixation at 10 years: rates of conversion to arthroplasty. Hip Int 2023;33(6):1086–1092. DOI: 10.1177/11207000221138040
  18. Moed BR, WillsonCarr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am 2002;84(5):752–758. DOI: 10.2106/00004623-200205000-00008
  19. Magu NK, Rohilla R, Arora S, et al. Modified Kocher-Langenbeck approach for the stabilization of posterior wall fractures of the acetabulum. J Orthop Trauma 2011;25(4):243–249. DOI: 10.1097/BOT.0b013e3181f9ad6e
  20. Chloros GD, Ali A, Kanakaris NK, et al. Surgical treatment of marginal impaction injuries of the acetabulum associated with posterior wall fractures. JBJS Essent Surg Tech 2022;12(1):e21.00004. DOI: 10.2106/JBJS.ST.21.00004
  21. Moed BR. The modified Gibson posterior surgical approach to the acetabulum. J Orthop Trauma 2010;24(5):315–322. DOI: 10.1097/BOT.0b013e3181c4aef8
  22. Heck BE, Ebraheim NA, Foetisch C. Direct complications of trochanteric osteotomy in open reduction and internal fixation of acetabular fractures. Am J Orthop 1997;26(2):124–128. PMID: 9040886.
  23. Ghalambor N, Matta JM, Bernstein L. Heterotopic ossification following operative treatment of acetabular fracture. an analysis of risk factors. Clin Orthop 1994 305:96–105. PMID: 8050252.
  24. Saterbak AM, Marsh JL, Nepola JV, et al. Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma 2000;14(4):230–237. DOI: 10.1097/00005131-200005000-00002
  25. Characteristics of elemental fracture types. AO, surgery reference, (accessed 14 January 2023).
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.