An unusual pattern of posterior wall fracture of acetabulum
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ORIGINAL ARTICLE
An unusual pattern of posterior wall fracture of acetabulum Vivek Trikha1 · Saubhik Das2 · Samarth Mittal1 · Buddhadev Chowdhury1 Received: 12 August 2020 / Accepted: 15 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
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. Keywords Acetabulum · Fracture · Posterior wall · Anterior displacement · Trochanteric flip osteotomy · Safe surgical dislocation
Introduction Posterior wall fractures are the most common variant accounting for nearly 25–33% of all acetabular fractures. They have been classified as an elementary type in original Letournel-Judet scheme of classification [1]. Very often they accompany posterior hip dislocation when timely reduction, congruous reconstruction and stable fixation with early physiotherapy hold the key to favourable outcomes [2]. However, the notion of simple fracture pattern, easy accessibility and * Vivek Trikha [email protected] 1
Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, AIIMS, Room No. 406, 4th Floor, Ring Road, New Delhi 110 029, India
Department of Orthopaedics, Rajindra Institute of Medical Sciences, Ranchi, Jharkhand, India
2
familiarity of orthopaedic surgeons has been call
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