寛骨臼柱骨折に対するワイヤー固定：整復の質と骨折型に応じた中期成績と生残率

Acetabular column fractures remain among the most complex injuries in orthopedic trauma. Conventional plating techniques require extensive soft-tissue dissection and are associated with high complication rates. The wiring technique, which achieves compression across both acetabular columns through the greater and lesser sciatic notches, was developed to minimize surgical morbidity. This study aimed to evaluate the mid-term clinical and radiologic outcomes of this technique and to analyze factors affecting hip joint preservation.

This retrospective study included 41 patients who underwent fixation of acetabular column fractures using the wiring technique between 1994 and 2018 at a single tertiary referral center. A dual approach combining the Kocher-Langenbeck and mini-iliofemoral incisions was used. Clinical outcomes were evaluated using the Harris Hip Score (HHS) and Visual Analog Scale (VAS), and radiologic reduction was graded according to Matta's criteria. Survivorship was analyzed using Kaplan-Meier methods with conversion to total hip arthroplasty (THA) as the endpoint.

The cohort included 29 men and 12 women, with a mean age of 51.2 years and a mean follow-up duration of 11.4 years. The mean operation time was 139.8 minutes. Intraoperative complications included one case each of superior gluteal artery injury, sciatic nerve palsy, and lateral femoral cutaneous nerve injury. Postoperative complications were rare. Anatomical or near-anatomical reduction was achieved in 97.5% of patients. The mean HHS and VAS at final follow-up showed satisfactory functional outcomes. Eight patients (19.5%) required conversion to THA during follow-up, resulting in an overall THA-free survival rate of 85%. Survival analysis demonstrated 100% survivorship for anatomical reductions, 75% for imperfect reductions, and 0% for poor reductions. Fracture classification did not influence clinical outcomes but significantly affected long-term survivorship, with anterior column fractures showing 100% survival and transverse with posterior wall fractures showing the lowest at 50%.

The wiring technique offers a reliable and biologically favorable method for treating acetabular column fractures. It provides stable reduction with limited soft-tissue disruption, resulting in durable mid-term hip preservation and low complication rates. These findings emphasize the importance of achieving anatomical reduction and support the wiring technique as an effective option for managing acetabular column fractures.