International Orthopaedics

, Volume 42, Issue 3, pp 673–679 | Cite as

A biomechanical comparison of different fixation techniques for fractures of the acetabular posterior wall

  • Xinbao WuEmail author
Original Paper



This study aimed to evaluate the biomechanical stability of different fixation techniques for fractures of the acetabular posterior wall. The hypothesis was that a reconstruction plate, combined with compression screw fixation and a plate placed lateral to the screws, would achieve a higher peak load to failure and stiffness and reduced gapping during cycle loading than other fixation techniques.


A total of 24 Sawbone pelvis models were created with simulated fractures at the posterior wall of the acetabulum. Anatomic reduction and internal fixation were performed randomly using one of four techniques: (A) reconstruction plate and compression screw fixation was placed with a plate medial to the screws; (B) plate and screw fixation with the plate located lateral to the screws; (C) plate fixation alone, and (D) screw fixation alone. Six models were tested in each group under cyclic and sustaining loading tests. Peak load to failure and stiffness were calculated from load displacement curves.


Peak load to failure and stiffness in group B (3698.71 N and 2900.48 N/mm, respectively), featuring reconstruction plate and compression screw fixation with the plate placed lateral to the screws, were significantly higher than groups C (2508.74 N, 1602.75 N/mm) and D (2332.06 N, 1454.26 N/mm). No statistical differences were observed when group A (2941.60 N, 2136.50 N/mm) was compared with the other groups. There were no significant differences in gapping between groups.


Fixation using a reconstruction plate and compression screws placed lateral to the screws may address acetabular posterior wall fractures in a more appropriate manner than techniques using only plates or screws. However, this study does not provide evidence to support the fact that placing the plate lateral to the screws is advantageous in comparison with other techniques.


Acetabular posterior wall Fracture Biomechanical study Fixation 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Letournel E, Judet R, Elson RA (1993) Fractures of the acetabulum. Springer, Berlin, pp 67, 189, 201Google Scholar
  2. 2.
    Epstein HC (1974) Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Joint Surg Am 56(6):1103–1127CrossRefPubMedGoogle Scholar
  3. 3.
    Saterbak A, Marsh J, Brandser E et al (1997) Outcome of surgically treated posterior wall acetabular fractures. Orthop Trans 21:627Google Scholar
  4. 4.
    Chiu FY, Lo WH, Chen TH, Chen CM, Huang CK, Ma HL (1996) Fractures of posterior wall of acetabulum. Arch Orthop Trauma Surg 115(5):273–275CrossRefPubMedGoogle Scholar
  5. 5.
    Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78(11):1632–1645CrossRefPubMedGoogle Scholar
  6. 6.
    Olson SA, Bay BK, Pollak AN, Sharkey NA, Lee T (1996) The effect of variable size posterior wall acetabular fractures on contact characteristics of the hip joint. J Orthop Trauma 10(6):395–402CrossRefPubMedGoogle Scholar
  7. 7.
    Moed BR, Carr SE, Gruson KI, Watson JT, Craig JG (2003) Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment. J Bone Joint Surg Am 85a(3):512–522CrossRefGoogle Scholar
  8. 8.
    Moed BR, Carr SE, Watson JT (2000) Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clin Orthop Relat Res 377:57–67CrossRefGoogle Scholar
  9. 9.
    Mitsionis GI, Lykissas MG, Motsis E (2012) Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: a study with a minimum follow-up of 15 years. J Orthop Trauma 26(8):460–465CrossRefPubMedGoogle Scholar
  10. 10.
    Olson SA, Bay BK, Chapman MW, Sharkey NA (1995) Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum. J Bone Joint Surg Am 77(8):1184–1192CrossRefPubMedGoogle Scholar
  11. 11.
    Moed BR, WillsonCarr SE, Watson JT (2002) Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am 84a(5):752–758CrossRefGoogle Scholar
  12. 12.
    Matta JM (2006) Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. J Orthop Trauma 20(1 Suppl):S20–S29PubMedGoogle Scholar
  13. 13.
    Olson SA, Kadrmas MW, Hernandez JD, Glisson RR, West JL (2007) Augmentation of posterior wall acetabular fracture fixation using calcium-phosphate cement: a biomechanical analysis. J Orthop Trauma 21(9):608–616CrossRefPubMedGoogle Scholar
  14. 14.
    Im GI, Shin YW, Song YJ (2005) Fractures to the posterior wall of the acetabulum managed with screws alone. J Trauma 58(2):300–303CrossRefPubMedGoogle Scholar
  15. 15.
    Ruedi T, Buckley R (2007) AO principles of fracture management. Thieme, Stuttgart, p 741Google Scholar
  16. 16.
    Shazar N, Brumback RJ, Novak VP, Belkoff SM (1998) Biomechanical evaluation of transverse acetabular fracture fixation. Clin Orthop Relat Res 352:215–222CrossRefGoogle Scholar
  17. 17.
    Mehin R, Jones B, Zhu Q, Broekhuyse H (2009) A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg 52(3):221–228PubMedPubMedCentralGoogle Scholar
  18. 18.
    Jiang Z, Zhang Q, Jiang H, Chen Z, Wu X (2005) Spatial characteristics of the Portevin-le Chatelier deformation bands in al-4 at%Cu polycrystals. Mater Sci Eng 403(1):154–164Google Scholar
  19. 19.
    Gao Y, Cheng T, Su Y (2015) High-efficiency and high-accuracy digital image correlation for three-dimensional measurement. Opt Lasers Eng 65:73–80CrossRefGoogle Scholar
  20. 20.
    Ni SJ, Sun JY, Wang YJ (2003) Biomechanical evaluation of the stability of the simulated fractures of the posterior wall of acetabulum. Chin J Orthop Trauma 5(4):347–350Google Scholar
  21. 21.
    Keith JE Jr, Brashear HR Jr, Guilford WB (1988) Stability of posterior fracture-dislocations of the hip. Quantitative assessment using computed tomography. J Bone Joint Surg Am 70(5):711–714CrossRefPubMedGoogle Scholar
  22. 22.
    Rowe C, Lowell J (1961) Prognosis of fractures of the acetabulum. J Bone Joint Surg Am 43:30–59CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedics, Beijing Jishuitan Hospital, The Fourth Medical CollegePeking UniversityBeijingChina

Personalised recommendations