Screw fixation of acetabular fractures

Between 1992 and 1995, 50 patients with 51 acetabular fractures underwent internal fixation using 3.5 mm cortical screws. There were 21 simple and 30 associated fracture types, as described by Letournel. Most of the patients had sustained multiple injuries with an average injury severity score (ISS) of 20 points. The modified extended iliofemoral approach was used in 32 cases, the Kocher Langenbeck approach in 9 cases, the ilioinguinal approach in 7 cases, the extended iliofemoral in 2 cases and the Kocher-Langenbeck approach combined with an ilioinguinal approach in a second stage procedure in 1. Anatomical reduction could be achieved with persistent displacement of no more than 1 mm in 40 fractures. Implant failure with loss of reduction occurred in 3 patients who underwent a revision procedure. At 2 year follow-up, 38 out of 44 of the patients had excellent or good clinical and radiological results. In acetabular fractures with sufficiently large fragments, screw fixation with 3.5 mm cortical screws proved satisfactory. In very comminuted fractures or where there is poor patient compliance an additional buttress plate should be used.