Functional Outcomes of Surgical Management of Posterior Wall Acetabular Fractures: A Prospective Study.

Introduction: Around 10% of the pelvic injuries involve acetabulum and approximately one-third of the acetabular fractures involve the posterior wall. These fractures are difficult to treat due to the complex three-dimensional (3D) anatomy, limitations of the surgical approaches due to important structures surrounding the acetabulum and extensive dissection of the large muscles around the hip. This prospective study aims to evaluate the functional outcomes of surgical management of posterior wall acetabular fractures, with or without associated bony injuries and posterior hip dislocation. Materials and Methods: The study was conducted in a tertiary care center during for a 2 year period. It included 20 patients aged 18-70 who presented with closed posterior wall acetabular fractures <21 days post-injury, adhering to established inclusion and exclusion criteria. Pre-operative assessment involved radiograph and computed tomography (CT) scans with 3D reconstruction. Kocher-Langenbeck approach was used, ensuring open reduction and internal fixation (ORIF) with reconstruction plates and screws. Outcomes were assessed using the modified Harris Hip Score (HHS). Patients were followed-up for a duration of 18 months during which complications were monitored. Results: The study included 20 patients with a mean age of 41.2 years and consisted predominantly of middle-aged males, with road traffic accidents being the leading cause of injury. Quality of reduction was evaluated using Matta's criteria, revealing anatomical reduction in 65% of cases. Functional assessment showed excellent outcomes in 15% of patients, good outcomes in 55%, fair outcomes in 20%, and poor outcomes in 10% according to the modified HHS. Statistical analysis demonstrated significant correlations between the timing of surgery, quality of reduction, and functional outcomes. Conclusion: Surgical management of posterior wall acetabular fractures using ORIF produced good-to-excellent functional outcomes in 70% of patients. Earlier surgery and anatomical reduction were significantly associated with better modified HHSs. These findings emphasize timely fixation and accurate reduction; however, larger studies with longer follow-up are required to validate the results.