ArticleMusculoskeletal surgery2026
Durability of posterior column fixation through the anterior-only approach: a prospective study for assessment of reduction loss.
Article in Musculoskeletal surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeDurability of anterior-only fixation for posterior column acetabular fractures remains debated, particularly regarding potential loss of reduction over time. This study prospectively evaluated radiographic stability and functional outcomes following fixation performed exclusively through the anterior approach.
methodsBetween 2019 and 2023, forty-five consecutive patients with displaced acetabular fractures requiring posterior column fixation were enrolled. All underwent reduction and fixation via the anterior approach in the supine position. Patients with old fractures (> 3 weeks), pathological fractures, or prior hip surgery were excluded. Standardized radiological assessments measured posterior column height and displacement immediately postoperatively and at 12-month follow-up (mean 15.6 ± 1.2 months). Reduction loss was defined as ≥ 2 mm displacement. Functional recovery was evaluated using the Harris Hip Score (HHS). Complications were prospectively recorded.
resultsMean age was 49.3 years. Radiological assessment showed minimal change between immediate postoperative and final follow-up: mean posterior column height increased 0.4 mm and posterior displacement 0.7 mm. No patient demonstrated displacement ≥ 2 mm. Functional outcomes were excellent, with mean HHS of 92.7 ± 6.4. Subgroup analysis revealed slightly lower scores in cases requiring posterior column fixation with infrapectineal buttressing (mean HHS 89.4 ± 5.1 vs. 94.1 ± 4.2, p < 0.05). One deep infection occurred (2.2% complication rate), managed successfully with debridement. No reoperation for fixation failure or nonunion was required.
conclusionAnterior-only fixation of posterior column acetabular fractures provided durable radiographic stability and excellent short-term functional outcomes at one year, with a low complication rate. While exclusion of irreducible fragments limits generalizability, these findings support the anterior intrapelvic approach as a reliable option in appropriately selected patients. Longer-term follow-up and comparative studies are warranted to determine its role relative to combined or posterior approaches.
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