Cement-Augmented Screw Fixation for Unreconstructible Acetabular Posterior Wall Fractures: A Technical Note

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomaterials Science

Background:

• Severely comminuted acetabular posterior wall fractures in young patients pose significant surgical challenges.
• Anatomical open reduction and internal fixation (ORIF) is often not feasible.
• Primary total hip arthroplasty (THA) is a suboptimal solution due to long-term implant concerns and revision inevitability.

Purpose of the Study:

• To present a novel joint-preserving technique for unreconstructible acetabular posterior wall fractures.
• To evaluate the efficacy of cement-augmented screw fixation using the Kocher-Langenbeck approach in a young, active patient.
• To offer an alternative to primary THA for complex acetabular injuries.

Main Methods:

• A single-patient technical note detailing a novel joint-preserving salvage procedure.
• Utilized cement-augmented screw fixation with polymethylmethacrylate (PMMA) bone cement via the Kocher-Langenbeck approach.
• Performed debridement, created a stable metallic framework with screws, contoured PMMA to reconstruct the articular surface, and reduced the hip.

Main Results:

• The patient, a 28-year-old male with a high-energy hip dislocation and comminuted acetabular fracture, underwent the novel procedure.
• At 21-month follow-up, the patient reported minimal pain during daily activities and deep squatting.
• Radiographic and CT evaluations showed a stable hip joint, concentric reduction, maintained joint space, and no implant loosening or osteolysis.

Conclusions:

• Cement-augmented screw fixation is a viable joint-preserving alternative to primary THA for unreconstructible acetabular posterior wall fractures in young patients.
• This technique provides immediate stability, facilitates early mobilization, and preserves bone stock.
• The case demonstrates promising functional and radiographic outcomes, suggesting a new option for complex acetabular injuries.