Reconstruction of unfixable comminuted posterior wall acetabular fractures with autologous bone graft: A systematic review.

Background: Posterior wall acetabular fractures, often caused by high-energy trauma, are complex injuries that pose significant surgical challenges, especially when comminuted. Traditional fixation techniques have shown variable outcomes, with severe comminution sometimes rendering fragment fixation impossible. The aim of this study was to evaluate the clinical and radiological outcomes of autologous bone grafting for reconstructing severely comminuted unfixable posterior wall acetabular fractures. Materials and methods: A systematic review was conducted in accordance with the PRISMA guidelines. The search for clinical studies was carried out across four databases: Embase, PubMed, Medline, and Scopus. The included studies were evaluated using the Coleman Methodology Score. The present study protocol was registered in PROSPERO. Results: The study involved 71 patients, with an average age of 37.12 years. Autologous iliac crest grafts were predominantly used, with the Kocher-Langenbeck approach in all cases. Clinical outcomes, assessed by Merle d'Aubigne and Harris Hip Scores, showed 78.9 % of patients reporting excellent to good results. Radiological outcomes indicated 66 % with excellent results per Matta's score. The overall success rate ranged from 57 % to 100 %, with a 5 % conversion to total hip arthroplasty. Complications were reported in 7 % of cases, including nonunion and avascular necrosis. Conclusion: Autologous bone grafts for comminuted, non-fixable posterior wall acetabular fractures may be considered as a potential salvage option in young patients, potentially delaying the need for THA.