Acetabular superior wall fractures: a distinct acetabular fracture entity

A transitional "grey-zone" exists between typical locations of classical trapezoidal anterior wall and large-fragment posterior wall acetabular fractures. Part of this grey zone is the superior acetabular dome, which is commonly involved in acetabular fracture patterns, especially in geriatric patients. The aim of this study was to characterize isolated acetabular superior wall fractures and to assess their relevance as a distinct fracture pattern.

A retrospective analysis of pelvic fracture databases from three tertiary trauma centers was performed. Acetabular fractures with superior dome involvement were screened, and cases with isolated superior articular involvement were included. Overall, seven patients were identified. Clinical and radiological data were analyzed regarding fracture morphology, associated fracture characteristics (including dislocation, comminution, marginal impaction, intra-articular fragments, and femoral head injury), concomitant pelvic ring injuries, treatment, and clinical outcomes.

Isolated superior wall acetabular fractures occurred following both high-energy and low-energy mechanisms, including simple falls. The mean age was 48 years and four of seven patients were male. Hip dislocation or subluxation was observed in four cases (anterior-superior or purely superior). Surgical treatment was performed in six cases, predominantly using anterior approaches (mainly the iliofemoral approach) with screw and/or plate fixation. Outcomes were frequently unfavorable, with relevant joint degeneration or persistent symptoms, likely related to substantial articular damage of the superior weight-bearing zone.

Acetabular superior wall fractures present a distinct fracture pattern that differs from classical anterior and posterior wall fractures and is less commonly observed. These injuries involve the superior weight-bearing dome and are frequently associated with comminution and substantial articular damage of both the acetabulum and femoral head. Even in cases with restored joint congruence, outcomes appear inferior, underscoring the clinical relevance of this fracture entity.