Defining Posterior Wall Fragments in Associated Both Column Acetabular Fractures (OTA/AO 62C)

Area of Science:

• Orthopedic surgery
• Traumatology
• Radiology

Background:

• Associated both column acetabular fractures (ABC) with concomitant posterior wall (PW) fracture fragments are not well-defined.
• Understanding the incidence and morphology of these complex fractures is crucial for effective treatment planning.

Purpose of the Study:

• To determine the incidence and describe the morphology of associated both column acetabular fractures with posterior wall fragments (ABC + PW).
• To analyze the relationship between fracture morphology and the required surgical approach.

Main Methods:

• Retrospective review of 152 associated both column acetabular fractures (2014-2020).
• Computed tomography (CT) scans with 3-D reformats were used to identify posterior wall fragments and analyze their morphology relative to the gluteal pillar.
• Surgical fixation methods and approaches were documented.

Main Results:

• Sixty-two of 152 (41%) ABC fractures had associated posterior wall fragments.
• Morphologic analysis revealed three types of PW fragments based on their relationship to the gluteal pillar (posterior, into, or anterior).
• Fixation strategies varied, with anterior approaches often sufficient for fragments extending into or anterior to the pillar, while posterior fragments sometimes required a separate posterior approach.

Conclusions:

• A posterior wall fragment is present in 41% of associated both column acetabular fractures.
• Fracture morphology, specifically its relation to the gluteal pillar, has significant implications for surgical treatment, potentially influencing the need for a separate posterior approach.
• The proposed classification may aid in updating fracture compendiums and guiding treatment decisions.