Articular compression molding techniques for acetabular posterior wall fracture

Abstract

Objective To evaluate the efficacy of articular compression molding techniques in the surgery for acetabular posterior wall fracture. Methods A retrospective study was conducted of the 28 patients (28 hips) with fracture of acetabular posterior wall plus comminuted compression of articular surface who had been treated using the articular compression molding techniques at Department of Orthopedics, The Hospital of 81 Group Army of PLA from January 2014 to January 2018. They were 25 males and 3 females, aged from 26 to 63 years (average, 49.3 years). The time from injury to surgery ranged from 4 to 12 days (average, 7.8 days). According to the Letournel-Judet classification, all were single element (simple) posterior wall fractures combined with posterior dislocation of the femoral head and articular compression of different degrees; transient sciatic nerve injury was complicated in 12 cases. The posterior hip dislocations were timely and successful reset at emergency treatment. The compression fractures of the posterior wall and hip joint were treated by open reduction and internal fixation via the acetabular posterior (K-L) approach. The articular compression was treated by 4 stabilization techniques: absorbable screwing and blocking technique in 10 cases, indwelling screwing in 12 cases, indwelling Kirschner wiring in 2 cases and die push and squeeze tamping in 4 cases. The operation time, intraoperative bleeding and complications were recorded. The therapeutic efficacy was evaluated by the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up. Results The operation time lasted from 76 to 118 minutes (average, 94.2 minutes); the intraoperative bleeding ranged from 100 to 320 mL (average,220.8 mL). No incision liquefaction, infection or other complications occurred. The 28 patients were followed up for 10 to 36 months (average, 17.6 months). According to the Matta scoring criteria, 24 cases achieved anatomical reduction but 4 dissatisfactory reduction. By the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up, the efficacy was evaluated as excellent in 26 cases and as good in 2. Heterotopic ossification was observed in 3 cases and microscopic free dense shadow in the joint cavity (about 2 mm in the round ligament) in 3 cases. There were no cases of obvious traumatic arthritis or osteoarthritis, femoral head necrosis, walking pain, lameness or hip abduction weakness. The 12 patients complicated with preoperative transient sciatic nerve injury recovered within 3 months after surgery. Conclusion The articular compression molding techniques can effectively treat severely comminuted articular compression in the acetabular posterior wall fracture and improve reduction of articular surface and hip joint matching, leading to stability and good joint function. Key words: Acetabulum; Hip fractures; Fracture fixation, internal; Articular compression; Reduction molding