Adequacy of single approach fixation in transverse-posterior wall fractures of the acetabulum: A case series of 55 patients with mid-term outcomes.

purposeTransverse-posterior wall (TPW) fractures of the acetabulum are complex injuries that require surgical fixation. The transverse component's major fracture line traverses the weight-bearing area and passes over the acetabular dome. The key to a successful outcome is anatomical reduction and rigid internal fixation. The treatment of TPW fractures has shown significant advancements, but there is still debate regarding the best surgical approach.

methodsThe study was conducted in a level 1 tertiary trauma care center, involving patients with an associated TPW fracture of the acetabulum. Between January 2015 and January 2023, a total of 512 acetabulum fractures were treated surgically. Out of which, 87 patients had a TPW fracture. Fifty-five patients who underwent surgical fixation using a single approach-Kocher-Langenbeck with a minimum 1-year follow-up-were included in this study. The exclusion criteria were patients with isolated transverse fractures, isolated posterior wall fractures, undisplaced fractures that were treated conservatively, TPW of acetabulum fractures treated using a combined surgical approach due to major displacement at the anterior column, open acetabulum fractures, and individuals who were unfit for surgery. Demographic details, epidemiology, fracture patterns, and associated skeletal and non-skeletal injuries were collected. Post-operative radiological results were graded according to the Matta score. Functional outcome analysis was done using the EuroQOL-5D score. The occurrence and rate of complications were evaluated.

resultsTPW fractures had an incidence of 17% among acetabulum fractures. The male-to-female ratio was 50:5, with an overall mean age of 40 years (range: 20-71 years). The mean follow-up was 32 months (range: 12-81 months). Among them, 41.8% had multiple injuries, 36.4% were polytraumatized. On arrival, 63.6% had hip dislocation, 14.5% had sciatic nerve injury. Anatomic reduction was achieved in 84.0% of the patients. Excellent to good functional outcomes were seen in 88.0%. An iatrogenic sciatic nerve injury was seen in 1 patient. Avascular necrosis, heterotrophic ossification, and post-traumatic osteoarthritis were seen in 16.4%, 21.8%, and 20.0%, respectively. The rate of conversion to total hip replacement was 10.9%.

conclusionSingle-approach fixation is adequate for TPW fractures of the acetabulum, where the anterior-column is well reduced, to provide satisfactory radiological results as well as an excellent-to-good functional outcome. Whenever the intraoperative roof-arc-angle is more than 45° and the displacement is less than 2 mm, the anterior column need not be addressed; however, if the roof arc angle is less than 45° and the displacement of more than 2 mm, an additional-lag-screw should be added.