PURPOSE We applied internal fixation using a spring plate against an acetabular posterior wall fracture including small fragments and then evaluated the clinical and radiological results and want to understand the usefulness of the spring plate. MATERIALS AND METHODS Fifteen patients in whom fixation was difficult using leg screws or a metal plate because of a small bone fragment, in patients with posterior wall acetabular fractures who presented in our hospital since August of 2011 to March of 2014 were enrolled. The mean age was 42.6 years (range 24-54 years) with relatively young patients, and they were followed-up for at least one year. We analyzed the rate of reduction after surgery using the classification of Matta in radiographs, and the classification of Borrelli in 3-dimensional computed tomography (CT) and clinical results were evaluated using the clinical grading system. RESULTS There were five cases of anatomical reduction, 9 cases of imperfect reduction, and 1 case of unsatisfactory reduction according to the classification of Matta. Except for one case during the follow-up period, the union of bone was successful without failure of fixation and the clinical results were 6 cases of excellence, 8 cases of good, and 1 case of failure. Articular displacement was also evaluated in postoperative CT scan according to Borrelli's criteria. The mean of gap and step off was 2.04 mm, 1.3 mm. CONCLUSION Use of leg screw fixation and so on in posterior wall fractures including a small fragment of the acetabular rim is not easy. However the method using spring plate fixation enables relatively accurate reduction and fixation for a small fragment and the clinical outcome showed satisfactory results.
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Biomechanical Comparison of Fixation Methods for Posterior Wall Fractures of the Acetabulum: Conventional Reconstruction Plate vs. Spring Plate vs. Variable Angle Locking Compression Plate HoeJeong Chung, Hoon-Sang Sohn, Jong-Keon Oh, Sangho Lee, DooSup Kim Medicina.2024; 60(6): 882. CrossRef
PURPOSE To evaluate the results of surgical treatment of posterior wall fractures of the acetabulum and to determine the factors affecting the results. MATERIALS AND METHODS Thirty-one posterior wall fractures were reviewed; 7 type A1-1, 19 type A1-2 and 5 type A1-3 by AO classification. Postoperatively, the accuracy of the reduction was evaluated. At the final follow-up, clinical and radiographic results were evaluated with medical records and radiographs. The factors affecting the results were determined. RESULTS The reduction was graded as anatomical in 22 patients, imperfect in seven and poor in two. The clinical result was excellent in 21 hips, good in six, fair in three and poor in one. The quality of the reduction was strongly associated with the clinical result. The radiographic result was excellent in 22 hips, good in five, fair in two and poor in two. The clinical result was related closely to the radiographic result. Complications were osteoarthritis in three patients, osteonecrosis of the femoral head in one, heterotopic ossification in one, penetration of a screw into the joint in one and iatrogenic sciatic nerve injury in one. The factors affecting the clinical results were fracture patterns, the surgeon's experience, the accuracy of the reduction and late complications. CONCLUSION In this present series of posterior wall fractures, as their prognosis depends on the severity of the injury and the accuracy of the reduction, satisfactory result can be obtained by anatomical reduction with thorough preoperative planning and the surgeon's experience.
The Posterior wall and column fracture of the acetabulum is clinically important because of its range of motion and weight bearing portion, and in majority cases, they accompany with posterior dislocation of the hip. When the fractures were not treateci well, they may give rise to disabling symptoms such as traumatic arthritis and avascular necrosis of the femoral head. So, accurate reduction is more important than other fractures. The purpose of this study is to know the clinical results and complications when reduced surgically the posterior wall fractures of acetabulum with posterior hip dislocation. Sixteen cases of posterior wall fracture of acetabulum with posterior hip dislocation were treated surgically in the presbyterian medical center during the period 1981 to 1995.
The short summary of observations were following as; 1. According to Letoumels classification, simple posterior wall fracture was 10 cases, comminuted posterior wall fracture in 4 cases, and posterior wall and column in 2 cases, and relatively good clinical result was seen at the simple posterior wall fracture.
2. The complications were traumatic osteoarthritis in 4 cases(25%), and heterotopic ossification in 2 cases(12.5%).
3. The clinical result above Good was 14 cases(88%), the roentgenographic result above Good was 11 cases(69%), and they were correlations in each others(P<0.05).
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Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction Sang-Hong Lee, Min-Kyu Shin, Sueng-Hwan Jo The Journal of the Korean Orthopaedic Association.2007; 42(2): 153. CrossRef