Outcomes of posterior wall acetabular fractures with marginal impaction using greater trochanter autografting: A prospective cohort study

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-23 DOI:10.1016/j.jcot.2025.103029

Dharmendra Kumar, Pranav Raghuwanshi, Ankit Sriwastava, Ravindra Mohan, Arpit Singh, Ashish Kumar

{"title":"Outcomes of posterior wall acetabular fractures with marginal impaction using greater trochanter autografting: A prospective cohort study","authors":"Dharmendra Kumar, Pranav Raghuwanshi, Ankit Sriwastava, Ravindra Mohan, Arpit Singh, Ashish Kumar","doi":"10.1016/j.jcot.2025.103029","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Posterior wall acetabular fractures with marginal impaction pose significant challenges, mainly because of the risk of joint incongruity and the potential for developing post-traumatic arthritis. Restoration of the articular surface and stability are essential to achieve good outcomes. This study investigates the surgical outcomes of posterior wall acetabular fractures with marginal impaction using the Kocher-Langenbeck (KL) approach, buttress plating, and greater trochanter autografting.</div></div><div><h3>Methods</h3><div>This prospective cohort study was conducted on 19 patients aged 18–60 years who were treated at a tertiary care center in North India. Fractures were confirmed by radiographic imaging and CT scans. The surgical procedure included articular dis-impaction, void filling with autografts, and fixation with anatomical reconstruction using plates and screws with mean Follow-up period was (mean ± SD) 1.86 ± 0.77 (Ranges:1–3 Years) The outcome was measured using Matta's criteria for radiological evaluation, and functional outcome using the Modified Merle d'Aubigné and Postel Score. Complications were noted, including infection, avascular necrosis (AVN), myositis ossificans, and secondary surgeries.</div></div><div><h3>Results</h3><div>The mean age was 37.58 ± 9.08 years, with a male predominance of 89.5 %. The most common cause was road traffic accidents, at 94.7 %. The most common fracture pattern noted was transverse with posterior wall fracture, with marginal impaction at 47.36 %, followed by isolated posterior wall fractures with marginal impaction at 42.10 %. Anatomical reduction was achieved in 73.7 % of cases, and the radiological outcomes at one year were excellent or good in 78.9 % of cases. Functional scores were excellent or good in 73.65 %. Complications included avascular necrosis with arthritis (21.1 %), myositis ossificans (10.5 %), infection (5.3 %), and conversion to total hip replacement in 10.5 % of cases.</div></div><div><h3>Conclusion</h3><div>Correction of impaction injuries with subchondral autografting and buttress plating via the KL approach provides satisfactory radiologic and functional results. However, associated injuries, particularly head injuries, are associated with poorer recovery outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"65 ","pages":"Article 103029"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Orthopaedics and Trauma","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0976566225001262","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Posterior wall acetabular fractures with marginal impaction pose significant challenges, mainly because of the risk of joint incongruity and the potential for developing post-traumatic arthritis. Restoration of the articular surface and stability are essential to achieve good outcomes. This study investigates the surgical outcomes of posterior wall acetabular fractures with marginal impaction using the Kocher-Langenbeck (KL) approach, buttress plating, and greater trochanter autografting.

Methods

This prospective cohort study was conducted on 19 patients aged 18–60 years who were treated at a tertiary care center in North India. Fractures were confirmed by radiographic imaging and CT scans. The surgical procedure included articular dis-impaction, void filling with autografts, and fixation with anatomical reconstruction using plates and screws with mean Follow-up period was (mean ± SD) 1.86 ± 0.77 (Ranges:1–3 Years) The outcome was measured using Matta's criteria for radiological evaluation, and functional outcome using the Modified Merle d'Aubigné and Postel Score. Complications were noted, including infection, avascular necrosis (AVN), myositis ossificans, and secondary surgeries.

Results

The mean age was 37.58 ± 9.08 years, with a male predominance of 89.5 %. The most common cause was road traffic accidents, at 94.7 %. The most common fracture pattern noted was transverse with posterior wall fracture, with marginal impaction at 47.36 %, followed by isolated posterior wall fractures with marginal impaction at 42.10 %. Anatomical reduction was achieved in 73.7 % of cases, and the radiological outcomes at one year were excellent or good in 78.9 % of cases. Functional scores were excellent or good in 73.65 %. Complications included avascular necrosis with arthritis (21.1 %), myositis ossificans (10.5 %), infection (5.3 %), and conversion to total hip replacement in 10.5 % of cases.

Conclusion

Correction of impaction injuries with subchondral autografting and buttress plating via the KL approach provides satisfactory radiologic and functional results. However, associated injuries, particularly head injuries, are associated with poorer recovery outcomes.

查看原文本刊更多论文

大转子自体移植术治疗髋臼后壁骨折伴边缘嵌塞的疗效：一项前瞻性队列研究

髋臼后壁骨折伴边缘内嵌带来了重大挑战，主要是因为关节不协调的风险和发展创伤后关节炎的潜力。关节面和稳定性的恢复是获得良好结果的必要条件。本研究探讨了采用Kocher-Langenbeck （KL）入路、支撑钢板和自体大转子移植术治疗髋臼后壁骨折伴边缘嵌塞的手术效果。方法本前瞻性队列研究对19名年龄在18-60岁的患者进行了研究，这些患者在印度北部的一家三级保健中心接受治疗。骨折经x线影像学和CT扫描证实。手术包括关节去除嵌塞，自体植骨填充空隙，用钢板和螺钉进行解剖重建固定，平均随访时间为（mean±SD） 1.86±0.77（范围：1-3年）。结果采用Matta放射学评价标准，功能结果采用改良Merle d' aubign和Postel评分。并发症包括感染、缺血性坏死（AVN）、骨化性肌炎和继发手术。结果患者平均年龄37.58±9.08岁，男性占89.5%。最常见的原因是道路交通事故，占94.7%。最常见的骨折类型是横向后壁骨折，边缘嵌塞发生率为47.36%，其次是孤立性后壁骨折，边缘嵌塞发生率为42.10%。73.7%的病例实现了解剖复位，78.9%的病例一年后的影像学结果为优或良。功能评分优或良者占73.65%。并发症包括无血管坏死伴关节炎（21.1%），骨化性肌炎（10.5%），感染（5.3%），10.5%的病例转为全髋关节置换术。结论经KL入路自体软骨下植骨加支撑板修复嵌塞损伤具有满意的影像学和功能效果。然而，相关损伤，特别是头部损伤，与较差的恢复结果相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.