Associated Transverse and Posterior Wall Fractures

Abstract

The association of a transverse fracture with a fracture of the posterior wall is frequent and represents the second largest group of our complex fractures, ranking just behind the both-column group and far ahead of our other three groups. The association has been recognised for a long time and is accompanied by dislocation of the femoral head which is more commonly posterior (117 cases, 64% of the total number of cases of this associated fracture) but sometimes central (60 cases, 32%). The mechanical theory, outlined in Chap. 2, explains and relates these sub-categories to the site and direction of impact. From a purely practical point of view, one could combine all of these fractures into one group because they are amenable to operative management through the same approach and have similar radiological characteristics, apart from the directions of dislocation. These are sometimes identical or so similar that it is impossible to conclude, from a radiological study of the fracture alone, which might be the direction of dislocation associated therewith. This notion is reinforced by the fact that in several cases a posterior dislocation has been converted after “reduction” into a central dislocation (see Fig. 12.10). The same fracture can therefore be associated with either type of dislocation.