Is Plating Fixation Through the Kocher-Langenbeck Approach for Associated Posterior Wall Fragment Indispensable in...

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Acetabular Fractures

Background:

• Treatment of posterior wall (PW) fractures in both-column acetabular injuries remains a clinical challenge.
• Surgical approaches and fixation methods for PW fragments are debated, impacting patient outcomes.

Purpose of the Study:

• To compare the quality of reduction, clinical outcomes, and complication rates between nonfixation of PW fragments and plating via the Kocher-Langenbeck (KL) approach.
• Evaluate outcomes for both-column acetabular fractures treated with anterior surgical procedures followed by either PW nonfixation or KL plating.

Main Methods:

• A retrospective study of 49 patients with both-column acetabular fractures treated from 2012-2017.
• Patients were divided into a Nonfix group (PW nonfixation) and a KL group (PW plating via KL approach).
• Data collected included operation duration, blood loss, reduction quality, fracture healing, complications, and functional outcomes using Merle d'Aubigné scores.

Main Results:

• The Nonfix group had significantly lower mean blood loss and operation durations compared to the KL group (p < 0.05).
• No significant differences were observed in mean hospital stay, fracture union time, satisfactory reduction rates (84.6% vs 87.0%), or mean Merle d'Aubigné scores (15.6 vs 16.2).
• The complication rate was significantly lower in the Nonfix group (7.7%) compared to the KL group (34.8%, p = 0.046).

Conclusions:

• Nonfixation of the posterior wall fragment in both-column acetabular fractures, following anterior surgical procedures, can achieve satisfactory outcomes.
• Nonfixation represents a less invasive surgical option with a reduced complication rate compared to Kocher-Langenbeck plating.