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An unusual pattern of posterior wall fracture of acetabulum

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

This study aims to describe an uncommon presentation of posterior wall acetabular fracture–dislocation with displacement of fracture fragment anterior to femoral head with its management and clinico-radiological outcome.

Methods

This retrospective review was performed at a Level I trauma centre over a period of six years. Hospital records, radiological database, operative register and follow-up data identified 7 patients with anteriorly lying posterior wall fragment of acetabulum. Analysis was performed with 6 patients having complete follow-up ranging from 2 to 7 years. The patients were operated with standard Kocher-Langenbeck approach; modification of this approach with trochanteric flip osteotomy and safe surgical dislocation was performed based on the location of the anteriorly lying fragment. Final functional and radiographic outcome was analysed according to modified Merle D’Aubigné and Postel score, and Matta’s grade, respectively.

Results

This uncommon presentation was observed in 11.11% of patients out of 63 patients with isolated posterior wall acetabular fractures managed during the study period. Anteriorly displaced posterior wall fragment was located in anterosuperior (n, 3), anterocentral (n, 2) and anteroinferior (n, 1) quadrants anterior to the femoral head. Final clinical and radiographic outcome revealed good-to-excellent outcome in 5 (83.33%) patients, and poor in one. One patient developed progressive arthrosis of hip which required total hip arthroplasty within 2 years.

Conclusion

This unusual pattern of posterior wall fracture requires adequate pre-operative planning, careful handling of the fractured fragments along with its soft tissue attachments during surgery, and preferably a concomitant trochanteric flip osteotomy with/without surgical hip dislocation to achieve good results.

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Funding

No funding or grants were received or will be received from any commercial party relating to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, AIIMS, Room No. 406, 4th Floor, Ring Road, New Delhi, 110 029, India

    Vivek Trikha, Samarth Mittal & Buddhadev Chowdhury

  2. Department of Orthopaedics, Rajindra Institute of Medical Sciences, Ranchi, Jharkhand, India

    Saubhik Das

Authors
  1. Vivek Trikha
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  2. Saubhik Das
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  3. Samarth Mittal
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  4. Buddhadev Chowdhury
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Contributions

All authors whose names appear on the submission VT made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data; or the creation of new software used in the work; SD drafted the work or revised it critically for important intellectual content; SM approved the version to be published; and BC agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Vivek Trikha.

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All procedures performed in this study involving human participants were in accordance with the ethical standard of the institutional and/ international research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

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Trikha, V., Das, S., Mittal, S. et al. An unusual pattern of posterior wall fracture of acetabulum. Eur J Orthop Surg Traumatol 31, 643–650 (2021). https://doi.org/10.1007/s00590-020-02814-z

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  • DOI: https://doi.org/10.1007/s00590-020-02814-z

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