Journal of Orthopedics and Joint Surgery

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

CLINICAL TECHNIQUE

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).


Abstract

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.


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