Outcome of Open Reduction and Internal Fixation of Posterior Acetabular Fractures

Abstract

Background:Acetabular fractures are a common clinical challenge. The posterior wall fractures represented 35% of all acetabular fractures and usually complexed. The curative treatment is surgical and depends on the fracture anatomy and surgeon preferences. Aim of the Work:The current study aimed to assess the short term results of posterior acetabular fractures management by open reduction and internal fixation. Patients and Methods:Thirty patients with displaced posterior wall acetabular fractures were included. They were treated by open reduction and internal fixation using neutralizing plates and screws. All patients were assessed by a pre-prepared trauma assessment sheet. Post-operative, active assisted and pain free passive range of motion exercises in all planes was advised. Functional outcome was evaluated using the Merle D'Aubinge and Postel score. Patients were followed up initially at 3 weeks intervals for first 2 months and thereafter at 6 weekly intervals for the next 6 months. Result:Patients were classified to two groups: Group [A] “70%” patients with isolated posterior wall fracture, and Group [B] “30%” of patients with posterior column plus posterior wall acetabular fracture. Both groups were comparable regarding age, gender, side and mode of trauma. The double plating fixation method was significantly increased in group B when compared to group A [77.8% vs. 0.0% respectively]. Group B was associated with significant increase of operative time than group A [164.44±13.33 vs. 128.57±27.80 minutes, respectively]. Blood loss significantly increased in group B than group A [1422.22±376.76 vs. 780.95±437.46 ml, respectively]. The excellent outcome was significantly associated with younger age, lower or absent complications, and anatomical [good quality] of direct postoperative radiological outcome. Conclusion: Most of our patients had an excellent and good outcome as a result to application of more strict selection criteria of patients and pattern.

Keywords

• acetabulum
• posterior wall
• fractures
• open reduction
• internal fixation