A surgical approach algorithm for transverse posterior wall fractures aids in reduction quality

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Skeletal reconstruction

Background:

• Transverse posterior wall fractures present treatment challenges, often leading to stiffness, arthritis, and pain.
• Traditional surgical approaches include the Kocher-Langenbeck and the higher-risk extended iliofemoral.
• No prior data exists on sequential anterior and posterior approaches for these fractures.

Purpose of the Study:

• To evaluate an algorithmic method for selecting surgical approaches for transverse posterior wall fractures.
• To determine if the algorithm ensures adequate reduction and stabilization for fracture union.
• Secondary endpoints included Merle d'Aubigne scores, reoperation rates, and radiographic complications.

Main Methods:

• Retrospective analysis of 65 patients with transverse posterior wall fractures treated by a single surgeon.
• An algorithm guided the choice between Kocher-Langenbeck (82%) and sequential approaches (18%) based on fracture characteristics.
• Follow-up averaged 23 months, assessing reduction adequacy, union, Merle d'Aubigne scores, and radiographic outcomes.

Main Results:

• The algorithm achieved 100% reduction within 1 mm on plain radiographs.
• Average Merle d'Aubigne score was 15.3, with 68% excellent/good radiographic arthritis scores.
• Complications included avascular necrosis (8%), THA (8%), infection (6%), and minimal heterotopic ossification.

Conclusions:

• The developed algorithm effectively guides surgical approach selection for transverse posterior wall fractures.
• It leads to accurate reduction and outcomes comparable to existing literature, avoiding more complex approaches.
• The algorithm serves as a valuable guide, but clinical judgment remains essential for individual patient care.