Isolated screw fixation of posterior wall fractures

Posterior wall (PW) fractures are common acetabular fractures and are most often treated by open reduction and internal fixation. The gold-standard of surgical stabilization is screw fixation of large wall fragments with additional buttress plating. Some reports focussed on screw fixation alone presenting adequate results.

From a total of 208 PW-fracture treated between 1972 and 2008, 57 patients were identified with open reduction and internal fixation (ORIF) using isolated screw fixation. These patients were analyzed regarding demographical data (patient age, sex), type of accident, injury mechanism, Injury Severity Score (ISS), concomitant pelvic ring injuries, associated injuries, perioperative parameters and long-term results.

44 patients were male and 13 were female with a mean age of 36.8 years. More than 90% sustained high-energy trauma with 34 sustaining multiple injuries or polytrauma. The mean Injury Severity Score was 11.5 points. All patients had fracture dislocations, which were reduced within 24 h after admission except one patient with secondary transfer. 11 patients presented with an initial sciatic nerve deficit. 29 patients had a single PW-fragment, 16 presented with two PW-fragments and in 12 patients marginal impactions were present. Surgery was performed in average after 7 days using the Kocher-Langenbeck approach. 24.6% femoral head lesions and 19.3% acetabular lesions were detected. All hips could be reconstructed anatomically. One patient died after severe head injury. 41 patients had follow-up of at least 12 months: 80.5% reported none or slight pain and 90.2% had good to excellent clinical results. 78% had no post-traumatic hip joint changes.

Screw fixation alone can be considered as a rare but adequate treatment modality in selected posterior wall fractures, especially minor comminuted fractures with predominantly a large single posterior wall fragment.