Results of surgical management of displaced posterior wall fractures of acetabulum: A prospective study in terms of functional outcome & complications

Abstract

Background: Treatment of patients with complex acetabular fractures, is one of the most difficult challenge for Orthopaedic surgeons. The purpose of this prospective study was to evaluate the results of surgical management of displaced posterior wall fractures of acetabulum and to determine the factors associated with an adverse outcome. Materials and Methods: After obtaining approval from local ethics committee, 29 patients, with the displaced posterior wall fractures of acetabulum, were managed by open reduction and rigid internal fixation through Kocher-Langenbeck approach and as per standard protocol. The results of follow-ups were analyzed clinically and radiologically, using the “Merle d’Aubigne & Postel score” and the “radiologic criteria of Matta” respectively at 1, 2, 3, 6, 9, 12 months and at 2 years post-operatively. Results: In our study, out of 29 patients, clinical results were very good in 41.4%, good in 20.7%, medium in 6.9%, fair in 10.3% and poor in 20.7% patients. Radiological results were excellent in 31%, good in 44.8%, fair in 6.9%, and poor in 17.3% patients. Heterotopic ossification (grade I in 10 patients, grade II in 4 patients, and grade III in 1 patient) and post-traumatic arthritis of the hip joint (3 patients) were the main complications observed during 2 years of follow-ups, which were treated accordingly. Conclusion: Management of the patients with displaced posterior wall fractures of acetabulum is a surgically demanding procedure with a learning curve to new surgeons. The clinical and radiological results depend on early anatomic reduction of fractured fragments, articular congruency of hip joint and the deliberate approach to soft tissues during surgery.