Marginal impaction in complex posterior wall acetabular fractures: role of allograft and mid-term results

  • Ramesh PerumalEmail author
  • Durga Prasad Valleri
  • Milkias Tsehaye Gessesse
  • Dheenadhayalan Jayaramaraju
  • Shanmuganathan Rajasekaran
Original Article • PELVIS - FRACTURES



To evaluate the functional and radiological outcome of complex posterior wall acetabular fractures with marginal impaction treated with cancellous allograft and internal fixation.


A total of 16 patients with marginal impaction on pre-operative CT scan, who underwent internal fixation and allograft were analysed. Mean follow-up was 28 months (range 24–42). The mean age was 46.5 years (range 22–71). Out of 16 patients, 8 were AO A1.2- and 8 were AO A1.3-type fractures. Functional evaluation was performed using modified Merle d’Aubigné and Postel scores and radiological evaluation by Matta’s criteria for quality of initial reduction and final outcome.


The quality of reduction was anatomical in 12 patients (75%) and imperfect in 4 patients (25%). The radiological outcome at final follow-up was excellent in 9 (56.25%), good in 5 (31.25%) and fair in 2 patients (12.5%). None of the patients had a secondary loss of reduction at final follow-up. Functional outcome was excellent in 2 (12.5%), good in 8 (50%) and fair in 6 patients (37.5%).


The use of cancellous allograft to fill the bone void provides good mechanical stability without any secondary loss of reduction. This surgical technique seems to be effective and safe in treating comminuted posterior wall fractures with marginal impaction without any donor site complications and other disadvantages of synthetic bone graft materials.


Marginal impaction Allograft Posterior wall fracture Acetabular fracture 



The authors wish to thank Dr. Sunny Parik, MBBS, BSc, MRCS, MSc ( for his contribution to improving the quality and format of the article.


No external funding received.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

Study is approved by an institutional review board.

Informed consent

Informed consent was obtained from all participants included in the study.


  1. 1.
    Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer, New YorkCrossRefGoogle Scholar
  2. 2.
    Brumback RJ, Holt ES, McBride MS et al (1990) Acetabular depression fracture accompanying posterior fracture dislocation of the hip. J Orthop Trauma 4:42–48CrossRefGoogle Scholar
  3. 3.
    Kreder HJ, Rozen N, Borkhoff CM et al (2006) Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall. J Bone Joint Surg [Br] 88-B:776–782CrossRefGoogle Scholar
  4. 4.
    Giannoudis PV, Tzioupis C, Moed BR (2007) Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint Surg [Br] 89-B:503–509CrossRefGoogle Scholar
  5. 5.
    Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H (2005) Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint Surg [Br] 87-B:2–9CrossRefGoogle Scholar
  6. 6.
    Bhandari M, Matta J, Ferguson T, Matthys G (2006) Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip. J Bone Joint Surg [Br] 88-B:1618–1624CrossRefGoogle Scholar
  7. 7.
    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-A:1632–1645CrossRefGoogle Scholar
  8. 8.
    Matta JM (1994) Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. Clin Orthop Relat Res 305:10–19CrossRefGoogle Scholar
  9. 9.
    Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg [Am] 55:1629–1632CrossRefGoogle Scholar
  10. 10.
    Kokubo Y, Uchida K, Takeno K et al (2013) (2013): dislocated intra-articular femoral head fracture associated with fracture-dislocation of the hip and acetabulum: report of 12 cases and technical notes on surgical intervention. Eur J Orthop Surg Traumatol 23(5):557–564CrossRefGoogle Scholar
  11. 11.
    Moed BR, Carr SE, Gruson KI et al (2003) Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment. J Bone Joint Surg [Am] 85:512–522CrossRefGoogle Scholar
  12. 12.
    Giannoudis PV, Tzioupis C, Papathanassopoulos A et al (2010) Articular step-off and risk of post-traumatic osteoarthritis: evidence today. Injury 41:986–995CrossRefGoogle Scholar
  13. 13.
    Brumback RJ, Holt ES, Poka A (1990) Acetabular depression fracture accompanying posterior fracture dislocation of the hip. J Orthop Trauma 4:42–48CrossRefGoogle Scholar
  14. 14.
    Saad TA et al (2016) Acetabular fractures with marginal impaction. Med J Cairo Univ 84(1):1071–1079Google Scholar
  15. 15.
    Martins e Souza P, Giordano V et al (2015) Marginal impaction in posterior wall fractures of the acetabulum. Am J Roentgenol 204(4):470–474CrossRefGoogle Scholar
  16. 16.
    Uchida K, Kokubo Y, Yayama T et al (2013) Fracture of the acetabulum: a retrospective review of ninety-one patients treated at a single institution. Eur J Orthop Surg Traumatol 23(2):155–163CrossRefGoogle Scholar
  17. 17.
    Giannoudis PV, Kanakaris NK, Delli Sante E et al (2013) Acetabular fractures with marginal impaction: mid-term results. Bone Joint J 95-B(2):230–238CrossRefGoogle Scholar
  18. 18.
    Leucht P et al (2013) Comparison of tricalcium phosphate cement and cancellous autograft as bone void filler in acetabular fractures with marginal impaction. Injury 44(7):969–974CrossRefGoogle Scholar
  19. 19.
    Kim et al (2011) Reconstruction of acetabular posterior wall fractures. Clin Orthop Surg 3(2):114–1120CrossRefGoogle Scholar
  20. 20.
    Guerado E, Cano JR, Cruz E (2012) Fractures of the acetabulum in elderly patients: an update. Injury 43(2):33–41CrossRefGoogle Scholar
  21. 21.
    Cornell CN (2004) Hip fractures in the elderly: on the acetabular side. Orthopaedics 27(931–932):17Google Scholar
  22. 22.
    Vanderschot P (2007) Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone. Injury 38:497–508CrossRefGoogle Scholar
  23. 23.
    Yun-tong Zhang, Yang Tang, Xue Zhao et al (2013) The use of a structural free iliac crest autograft for the treatment of acetabular fractures. Arch Orthop Trauma Surg 133(6):773–780CrossRefGoogle Scholar
  24. 24.
    Ramesh KS, Sujit KT, Sameer A, Tajir T (2011) Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture. Int Orthop 35:1223–1228CrossRefGoogle Scholar
  25. 25.
    Khira YM, El-Aidy S (2018) Surgical treatment of marginal osteochondral impaction in acetabular fractures. Musculoskelet Surg 102:139CrossRefGoogle Scholar
  26. 26.
    Almaiman M, Al-Bargi HH, Manson P (2013) Complication of anterior iliac bone graft harvesting in 372 adult patients from May 2006 to May 2011 and a literature review. Craniomaxillofac Trauma Reconstr 6(4):257–266CrossRefGoogle Scholar
  27. 27.
    Dimitriou R, Mataliotakis GI, Angoules AG et al (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury Int J Care Inj 42:S3–S15CrossRefGoogle Scholar
  28. 28.
    Ahlmann E, Patzakis M, Roidis N et al (2002) Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Jt Surg, JBJSOrg A number 5:716–720CrossRefGoogle Scholar
  29. 29.
    Kim DH, Rhim R, Li L, Martha J et al (2009) Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 9:886–892CrossRefGoogle Scholar
  30. 30.
    Schubert T T, Big E, Van Isacker T et al (2012) Analysis of predisposing factors for contamination of bone and tendon allografts. Cell Tissue Bank 13(3):421–429CrossRefGoogle Scholar
  31. 31.
    Kainer MA, Linden JV, Whaley DN et al (2004) Clostridium infections associated with musculoskeletal-tissue allografts. N Engl J Med 350:2564–2571CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Ramesh Perumal
    • 1
    Email author
  • Durga Prasad Valleri
    • 1
  • Milkias Tsehaye Gessesse
    • 1
  • Dheenadhayalan Jayaramaraju
    • 1
  • Shanmuganathan Rajasekaran
    • 1
  1. 1.Division of Orthopaedics, Trauma and Spine SurgeryGanga HospitalCoimbatoreIndia

Personalised recommendations