Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures

Background: The incidence of acetabular fractures has increased following road traffic accidents. The aim of the study is to evaluate functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum.Methods: This is a prospective study done at Nizam’s Institute of Medical Sciences, Hyderabad between May 2018 and May 2020. The sample size is 20 patients between the age group 18-60 years who presented to the hospital with closed posterior wall and/or column fractures of acetabulum with or without posterior dislocation of hip joint. Functional outcome is assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication are assessed by retrospectively analyzing medical records and radiographics examination.Results: Functional outcome according to Merle D’ Aubigne and Postel score 16 patients (75%) showed good, 3 patients (20%) showed fair, 1 patient (5%) showed poor outcome. Radiological outcome according to Matta criteria, 16 patients (75%) showed excellent quality of joint reduction, 4 patients (25%) showed good quality of reduction of joint. There was significant correlation between anatomic reduction of the joint surface and functional outcome of the patient in our study (p value <0.05).Conclusions: Accurate joint reduction is of utmost importance in reduction of posterior wall or column fractures of acetabulum as posterior wall is the weight bearing zone. Functional outcome depends on fracture type, associated injuries, selection of patient, time between injury and surgery and postoperative rehabilitation.

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1085 Equestrian Related Pelvic and Acetabular Fractures – Experience from a Major Trauma Centre in England

British Journal of Surgery ◽

10.1093/bjs/znab259.1025 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Hussain ◽

M Ghobrial ◽

B Davies ◽

P Hull ◽

A Carrothers ◽

...

Keyword(s):

Major Trauma ◽

Weight Bearing ◽

Posterior Wall ◽

Anterior Wall ◽

Open Reduction Internal Fixation ◽

Trauma Centre ◽

Acetabular Fractures ◽

Sufficient Information ◽

Horse Riding ◽

Major Trauma Centre

Abstract Introduction Equestrianism is enjoyed by three million people in the UK; however, there is a lack of literature on pelvic and acetabular (P&A) injuries incurred through the sport. We aim to describe P&A injuries sustained in equestrian accidents, discuss management, and establish their outcomes. Method Data was extracted from a prospectively collected database of referrals to the P&A Service of a Major Trauma Centre (MTC) from 01/01/2016 to 31/12/2020 and cross-referenced with medical records. Results 60 of the 1,218 P&A referrals were secondary to horse-riding accidents. Mean age 45 (SD 16.59); 46 female; 33 managed non-operatively and 27 managed operatively at the MTC. There was sufficient information for 59 cases to be classified; 46 of the injuries were pelvic fractures (10 anterior-posterior compression; 29 lateral compression; 4 sacral and 3 pubic rami fractures) and 13 were acetabular (2 anterior column; 1 anterior wall; 2 associated both columns; 1 posterior column and posterior wall; 1 posterior wall; 2 T-shaped and 4 transverse fractures). The operative group were managed by examination under anaesthesia (n = 3), open reduction internal fixation (n = 22) or percutaneous fixation (n = 2). Mean hospitalisation was 9.2 days (SD 5.44). 81% were non-weight-bearing post-operatively and mean time to independent mobilisation was 12.6 weeks (SD 7.09). Return-to-riding information was available for 8 patients with a mean of 29.5 weeks (SD 11.55). Conclusions Equestrianism can result in significant P&A injuries. Patients should be counselled that they may have a long recovery, a protracted return-to-riding time and some may never return to the sport.

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Study and results of reconstruction plating in fracture posterior column and posterior wall of acetabulum

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174665 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1104

Author(s):

Nilesh Indulal Kachnerkar ◽

Pravin Markade

Keyword(s):

Surgical Complication ◽

Weight Bearing ◽

Posterior Wall ◽

Lateral Position ◽

Acetabular Fractures ◽

X Rays ◽

Radiological Results ◽

Acetabulum Fractures ◽

Cancellous Screws

Background: Posterior acetabulum fractures are the most common type of acetabular fractures. Acetabular fracture was an enormous orthopaedic problem in which the treatment was grossly inadequate and many patients were left with incapacitating pain. These fractures were often feared because of the poor outcome in many patients treated non-operatively. There are few published studies with a prolonged follow up. Thus this study was to review the displaced posterior acetabular fractures treated operatively in our hospital during last 5 years with regards to clinical, radiological results, the rate of surgical complication and the rate of successful fracture reduction.Methods: The patients with posterior acetabulum fractures were diagnosed on basis of clinical suspicion and confirmed on x-rays and CT scans. Displaced fractures were treated surgically in lateral position through Kocher-Langenbeck approach and fractures were fixed with reconstruction plates and cancellous screws and results studied.Results: Clinical grading was based on Merle d’Aubigne and Postel scoring which has been modified by Matta, According to this scale excellent to good results seen in 76.66% and fair results seen in 23.33% of cases. Radiological assessment grading according to the criteria developed by Matta, According to this criteria excellent to good radiological results are seen in 79.66% and poor results in 6.66% of cases. Conclusions: Displaced posterior acetabular fractures treated by open reduction and internal fixation with anatomical reduction allow early mobilisation and weight bearing and gives excellent results.

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Posterior wall acetabular fractures: update on surgical indications, fixation techniques and outcome measurements

Current Orthopaedic Practice ◽

10.1097/bco.0b013e3181b3a5f2 ◽

2009 ◽

Vol 20 (5) ◽

pp. 511-521 ◽

Cited By ~ 1

Author(s):

Greg M Osgood

Keyword(s):

Posterior Wall ◽

Acetabular Fractures ◽

Surgical Indications ◽

Outcome Measurements ◽

Fixation Techniques

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Excessively Long Interfragmentary Screws for Posterior Wall Acetabular Fractures Can Predict Intraarticular Penetration

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2022.103202 ◽

2022 ◽

pp. 103202

Author(s):

Christopher L. Hoehmann ◽

Michael DiVella ◽

Nathan S. Osborn ◽

Joshua Giordano ◽

Joshua Fogel ◽

...

Keyword(s):

Posterior Wall ◽

Acetabular Fractures

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Are CT Scan Interpretations by Surgeons Reliable and Reproducible in Determining Instability with Posterior Wall Acetabular Fractures?

JBJS Orthopaedic Highlights Trauma ◽

10.2106/jbjs.ot.k.00109 ◽

2011 ◽

Vol 1 (4) ◽

Author(s):

Kyle J. Jeray

Keyword(s):

Ct Scan ◽

Posterior Wall ◽

Acetabular Fractures

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Acetabular Fractures in the Elderly

Clinical Medicine Insights Trauma and Intensive Medicine ◽

10.4137/cmtim.s12265 ◽

2015 ◽

Vol 6 ◽

pp. CMTIM.S12265 ◽

Cited By ~ 1

Author(s):

Joshua L. Gary

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Fracture ◽

Open Reduction ◽

Weight Bearing ◽

Revision Arthroplasty ◽

Early Mobilization ◽

Acetabular Fractures ◽

Posttraumatic Arthritis ◽

Total Hip

As the population ages, the incidence of osteoporotic fractures, including those of the pelvis and acetabulum, continues to rise. Treatment of the elder patients with an acetabular fracture is much more controversial than the treatment of younger patients with similar injuries, where prevention of posttraumatic arthritis and total hip replacement remains optimal to limit need for revision arthroplasty. Arthroplasty for fractures of the proximal femur is commonplace in an older population and is a mainstay of treatment to promote early mobilization and weight-bearing. However, even with acute total hip arthroplasty for a geriatric acetabular fracture, most surgeons do not permit immediate weight-bearing postoperatively. Therefore, controversy regarding optimal treatment of these challenging fractures persists. Four treatment options have emerged: nonoperative treatment with early mobilization, open reduction and internal fixation (ORIF), limited open reduction and percutaneous screw fixation, and acute total hip arthroplasty. The exact indications and benefits of each treatment remain unknown. This article serves as a review of these four treatments and the data existing to support them.

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