Is the Posterior Wall Avulsion the Simplest Acetabular Fracture?

Abstract

The posterior wall fracture – the most frequent acetabular lesion – is often regarded as the simplest acetabular fracture. In fact, a large variety of complex articular lesions is subsumed under this fracture type.

A consecutive series of 60 posterior wall fractures is reviewed retrospectively. Lesions characteristics, treatment method, early and late postoperative complications a 2-year functional results were recorded.

In 27 patients (45%), additional damage to the cartilage of the acetabular cavitiy such as subchondral impaction, free articular fragments of separation of the posterior wall into several pieces was present. Seven patients (11.6%) showed preoperative neurologic deficit. Secondary nerve damage was present in 8.3%. During the first 2 years, additional surgery was performed in 7/46 patients (15.2%). The rate of periarticular ossifications amounted to 26.1%. The rate of excellent and good results was 69.5%.

Posterior wall fracture of the acetabulum is a more complex injury than generally accepted. The trauma surgeon's task is to complete identify the lesion and to consider all aspects of the injury during surgery and rehabilitation. Even in experienced hand, excellent and good long-term results will not excee 75%. Poor results are due to the difficulty of posterior wall reconstruction, partial osteonecrosis and/or complications caused by the Kocher-Langenbeck approach.