Journal of Musculoskeletal Trauma

Systematic Review

Impact of posterior wall involvement and fixation on clinical and radiographic outcomes of associated both-column acetabular fractures: a systematic review and meta-analysis: Chul-Ho Kim, Eic Ju Lim; J Musculoskelet Trauma 2026;39(4):310-322. Published online October 19, 2026; DOI: https://doi.org/10.12671/jmt.2026.00248

Abstract PDF Supplementary Material: Background
Posterior wall (PW) fractures are frequently associated with both-column (ABC) acetabular fractures. However, whether the presence of a PW fragment or the need for internal fixation affects prognosis remains a topic of debate. This study compared postoperative outcomes, including reduction quality and clinical results, according to the presence of an associated PW fracture and whether PW fixation was performed.
Methods
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. MEDLINE, Embase, and the Cochrane Library were searched for articles published up to December 10, 2025. Comparative studies of ABC fractures were included if they evaluated the presence or absence of PW involvement or compared internal fixation with nonfixation of the PW component. Clinical and radiographic outcome data were extracted.
Results
Seven retrospective studies including 434 analyzable patients were included. No clear differences were found in the odds of poor reduction (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.43–1.94; P=0.80), osteoarthritis (OR, 1.04; 95% CI, 0.37–2.92; P=0.94), or conversion to total hip arthroplasty (OR, 0.63; 95% CI, 0.23–1.71; P=0.36) according to the presence of a PW fragment in ABC fractures. Among ABC fractures with PW involvement, nonfixation was associated with numerically higher odds of poor reduction than fixation, although the difference was not statistically significant (OR, 1.47; 95% CI, 0.46–4.76; P=0.52). In unadjusted comparisons of non-randomized cohorts, PW fixation was associated with significantly longer operative time (mean difference [MD], 70.38 min; 95% CI, 24.46–116.29; P=0.003) and greater intraoperative blood loss (MD, 351.36 mL; 95% CI, 244.97–457.74; P<0.00001). The final modified Merle d'Aubigné-Postel score did not differ significantly between the fixation and nonfixation groups (MD, 0.58 points; 95% CI, −0.57 to 1.74; P=0.32).
Conclusions
Current evidence does not clearly support routine fixation of all PW fragments. In unadjusted comparisons of non-randomized cohorts, patients who underwent PW fixation had longer operative time and greater blood loss. These differences cannot be attributed to fixation itself because of confounding by indication and the frequent use of an additional posterior approach. Selective fixation based on residual displacement, joint congruency, and hip stability appears reasonable, although the certainty of evidence remains limited. Level of evidence: Not applicable.

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Original Article

Clinical and radiographic outcomes after surgical treatment of supination-adduction type ankle fractures in older (≥65 years) and younger (<65 years) patients: a retrospective single-center comparative study in Korea: JungHo Lee, Bawoo Ko, Hongik Choi, Jun-young Lee; J Musculoskelet Trauma 2026;39(3):236-244. Published online July 24, 2026; DOI: https://doi.org/10.12671/jmt.2025.00374

Abstract PDF: Background
Supination-adduction (SAD) ankle fractures involve a vertical medial malleolar fracture and potential tibial plafond impaction, but pattern-specific evidence in older patients remains limited. We compared postoperative complications and clinical/radiographic outcomes between older and younger patients and explored complication-associated factors within the older group.
Methods
We retrospectively reviewed 51 patients who underwent surgery for SAD-type ankle fractures (2010–2020): 30 younger (<65 years) and 21 older (≥65 years). The primary outcome was a composite of surgical site infection, loss of reduction, or delayed union. Functional recovery was assessed using Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores through 12 months. Union and posttraumatic osteoarthritis were assessed radiographically at ≥18 months. Preoperative dual- energy X-ray absorptiometry was performed in older patients for exploratory analyses.
Results
Postoperative complications were higher in the older group (38.1% vs. 10.0%, P=0.035). In older patients, diabetes mellitus was associated with complications (odds ratio [OR], 9.17; 95% confidence interval [CI], 1.15–73.24; P=0.037); smoking was not (OR, 5.50; 95% CI, 0.71–42.60; P=0.103). At 12 months, OMAS and AOFAS scores did not differ significantly. One older patient developed nonunion, and posttraumatic osteoarthritis occurred in one patient per group. Lower T-scores (mean, −2.3±0.5) correlated with greater tibial plafond impaction depth (3.1±1.2 mm; ρ=−0.46, P=0.036) and showed a borderline significant correlation with articular step-off (2.0±0.8 mm; ρ=−0.43, P=0.052).
Conclusions
Older patients had higher postoperative complication rates than younger patients, although 12-month functional and late radiographic outcomes were comparable. Diabetes was associated with complications, though the small sample warrants cautious interpretation. Findings support careful perioperative optimization and individualized fixation based on fracture morphology and bone quality in older patients, especially those with diabetes. Level of evidence: III.

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