Comminuted fractures of the posterior wall of the acetabulum. A biomechanical evaluation of fixation methods
Goulet, J.A.; Rouleau, J.P.; Mason, D.J.; Goldstein, S.A.
Journal of Bone and Joint Surgery. American Volume 76(10): 1457-1463
1994
ISSN/ISBN: 0021-9355 PMID: 7929492 Document Number: 436711
Reproducible simple fractures and osteotomies of the posterior wall of the acetabulum were created in twenty paired hemipelves from fresh human cadavera. Comminution was created with an additional fracture line that was either parallel (concentric comminution) or perpendicular (transverse comminution) to the posterior rim of the acetabulum. Under simulated weight-bearing, the stiffness of fixation of the transversely comminuted fractures that had been achieved with use of a reconstruction plate and screws was significantly higher than that achieved with fixation with screws alone (p lt 0.05). The load to failure of the fixation of transversely comminuted fractures treated with a reconstruction plate and screws was also significantly higher than that of fixation of such fractures with screws alone (p = 0.05). The load to failure of the fixation of concentrically comminuted fractures was significantly higher when a reconstruction plate and accessory spring plates had been used than when a reconstruction plate alone had been employed (p lt 0.05). CLINICAL RELEVANCE: Secure fixation of fractures of the posterior wall of the acetabulum is critical since loss of fixation results in chronic instability and limited options for reconstruction. The data from the present study support our clinical observations that, for transversely comminuted fractures, fixation with a buttress plate is stronger than fixation with screws alone and that supplementary fixation with spring plates may help to prevent redisplacement of concentrically comminuted fractures of the posterior wall of the acetabulum.