Outcomes are equivalent for two-column acetabular fractures either with or without posterior-wall fractures
It is likely that posterior-wall involvement in association with two-column fractures plays a pivotal role in outcomes because of the potential for hip instability if it is not anatomically reduced and fixed. Uncertainty remains about how this fracture is best treated, especially regarding how posterior-wall involvement may affect functional results.
Materials and methods
To better understand the role that posterior-wall involvement may play in determining functional results, we compared data for outcomes for patients with posterior-wall involvement and for those without in a consecutive series of two-column fractures. Between 2000 and 2013, 42 patients who underwent surgical treatment for two-column acetabular fractures were evaluated after a minimum follow-up period of 1 year. Data were prospectively collected and retrospectively evaluated. Of the 42 patients, 25 had only a two-column fracture (group 1) and 17 had a two-column fracture with posterior-wall involvement (group 2).
There were no differences between groups in terms of reduction accuracy, radiographic results, clinical results, or complication rates. All hips in patients with internal fixation for the associated posterior-wall fracture had anatomical reduction. At the latest follow-up evaluation, three patients from group 1 (without posterior-wall involvement) and three patients from group 2 (with posterior-wall involvement) had undergone total hip arthroplasty.
These results suggest that a posterior-wall fracture in a two-column fracture does not compromise functional outcomes when the treatment algorithm discussed here is followed.
KeywordsAcetabulum Two-column fracture Posterior-wall fracture Ilioinguinal approach
Medical editor Katharine O’Moore-Klopf, ELS (East Setauket, NY, USA) provided professional English-language editing of this article.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article had obtained approval of the Medical Center’s Institutional Review Board.
- 1.Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151:81–106Google Scholar
- 8.Tile M (2003) Describing the injury: classification of acetabular fractures. In: Tile M, Helfet D, Kellam J (eds) Fractures of the pelvis and acetabulum, 3rd edn. Lippincott Williams & Wilkins, Baltimore, MD, pp 427–475Google Scholar
- 9.Larson CB (1973) Fracture dislocations of the hip. Clin Orthop Relat Res May (92):147–154Google Scholar
- 11.Matta JM (1994) Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective. Clin Orthop Relat Res Aug (305):10–19Google Scholar
- 16.Mears DC, MacLeod MD (2003) Acetabular fracture: TRI and MTRI approaches. In: Tile M, Helfet D, Kellam J (eds) Fractures of the pelvis and acetabulum, 3rd edn. Lippincott Williams & Wilkins, Baltimore, MD, pp 585–588Google Scholar