Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum
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 c...
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Jaypee Brothers Medical Publisher
2024-01-01
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| Series: | Journal of Orthopedics and Joint Surgery |
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| Online Access: | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1138 |
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| author | Kingsly Paulraj Sathish Muthu |
| author_facet | Kingsly Paulraj Sathish Muthu |
| author_sort | Kingsly Paulraj |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0ef64c889cf74d47a0ab7377729fa162 |
| institution | Kabale University |
| issn | 2582-7863 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Jaypee Brothers Medical Publisher |
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| series | Journal of Orthopedics and Joint Surgery |
| spelling | doaj-art-0ef64c889cf74d47a0ab7377729fa1622025-02-07T11:17:47ZengJaypee Brothers Medical PublisherJournal of Orthopedics and Joint Surgery2582-78632024-01-0161747810.5005/jojs-10079-113814Strategies in Management of Posterosuperior Wall Fracture of the AcetabulumKingsly Paulraj0https://orcid.org/0000-0002-7143-3095Sathish Muthu1https://orcid.org/0000-0002-7143-4354Department of Orthopaedics, Government Medical College, Kanyakumari, Tamil Nadu, IndiaDepartment of Orthopaedics, Government Karur Medical College & Hospital, Karur; Orthopaedic Research Group; Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India, Phone: +91 9600856806Introduction: 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.https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1138acetabular fractureinternal fixationkocher–langenbeck approachposterosuperior fractureposterior wall |
| spellingShingle | Kingsly Paulraj Sathish Muthu Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum Journal of Orthopedics and Joint Surgery acetabular fracture internal fixation kocher–langenbeck approach posterosuperior fracture posterior wall |
| title | Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum |
| title_full | Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum |
| title_fullStr | Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum |
| title_full_unstemmed | Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum |
| title_short | Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum |
| title_sort | strategies in management of posterosuperior wall fracture of the acetabulum |
| topic | acetabular fracture internal fixation kocher–langenbeck approach posterosuperior fracture posterior wall |
| url | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1138 |
| work_keys_str_mv | AT kingslypaulraj strategiesinmanagementofposterosuperiorwallfractureoftheacetabulum AT sathishmuthu strategiesinmanagementofposterosuperiorwallfractureoftheacetabulum |