Objective
We evaluated clinical and radiographic outcomes in patients with displaced combined acetabular fractures, with or without lag-screw fixation, managed over a period of 3 years using a posterolateral single approach, direct posterior wall and posterior column reduction and plating, and indirect reduction of the anterior column controlled using fluoroscopic imaging. The aim of this study was to identify whether the Matta radiographic roof-arc angles obtained immediately after fracture reduction and fixation change in the postoperative period when comparing posterior plating alone with posterior plate and anterior column lag-screw fixation.
Patients and methods
A total of 35 skeletally mature patients (31 men and four women, with a mean age of 39.9 years, range 23.3-.7 years) with combined transverse-posterior wall acetabular fractures surgically treated using a posterolateral single approach were enrolled in this study. The first part of the acetabular fracture management consisted of anatomical reduction and fixation of the transverse posterior component, followed by anatomical reduction and fixation of the posterior wall component. The transverse anterior component reduction was controlled using fluoroscopic imaging (anteroposterior, iliac-oblique, and obturatoroblique views) and digital palpation through the greater sciatic notch. Of the 35 patients, 15 underwent an additional lag-screw fixation from the posterior to the anterior columns using an extra-long small-fragment cortical screw. Anteroposterior and Judet oblique radiographic views were imaged at the end of the procedure, and roof-arc angles were measured. Clinical results were assigned according to the grading system of Merle D'Aubigne and Postel as modified by Matta and colleagues. Radiographic roof-arc angles were measured and compared between the two groups of patients at the time of the surgical procedure and at 3 months postoperatively.
Results
During the final follow-up examination 18-60 months postoperatively (mean, 36.8 months), the clinical results were considered satisfactory in 31 (88.6%), excellent in nine (25.7%), and good in 22 (62.9%) patients. There was no difference between patients with (=15) and without (=20) fixation of the transverse anterior component of the acetabular fracture. Radiographic roof-arc angles measured during discharge, at 3 months postoperatively, and at the last follow-up consultation did not change significantly.
Conclusion
Associated transverse-posterior wall acetabular fractures can be managed using a single posterior approach. If there is adequate indirect reduction of the anterior column, as checked by digital palpation and fluoroscopy, it is not necessary to fix the anterior column component of the transverse acetabular fracture.