Implant utilization for posterior wall fractures of the pelvis: a narrative review

Many fixation options exist for the treatment of posterior wall fragments in acetabular fractures, however, there is a limited amount of comparative clinical studies. In current practice, the most common methods of fixation in posterior wall fractures include traditional buttress compression plating along with spring plates. Conversely, recent studies have been published showing the use of non-traditional implants that have been found to produce good clinical outcomes. The purpose of this study is to analyze and compare the various implants used in posterior wall acetabular fractures on a global scale. Within this review of literature, a search was done using Medline (PubMed) and EMBASE databases. The search strategy incorporated a combination of free-text keywords and MeSH (Medical Subject Headings) terms, including: "posterior wall fractures," "plates," "plate," "device," "hardware," "treatment," and related terms. In total, 157 published articles were initially found. After primary, secondary, and tertiary screenings, 16 published reports were found to focus on specific implants used in posterior wall fractures. Among the literature, reports focusing on common implants such as buttress plating, reconstruction plates, and spring plates were found. Additionally, the use of new variations of plates has been published and found promising results. Novel ideas for fixation, including 3D printed templates for plating, combined plate methodology, locking compression pilon plates, H-shaped anatomical plates, and W-shaped angular plates were all found to show improvement, either clinically or biomechanically, in comparison to traditional implants. With the increased utilization of technology and 3D printing resources, many institutions throughout the world are utilizing non-traditional implants to provide more structurally durable implants to improve clinical outcomes. Due to the complexity of posterior wall fractures in isolation and associated with other fracture patterns, multiple implants are being used to enhance stabilization, loss of reduction, and the number of revision surgeries. The purpose of this review is to summarize the current literature available on implant options for posterior wall fractures.