Pelvic and Acetabular Fracture
Treatment of comminuted posterior acetabular wall fractures with structural autologous iliac bone graft combined with mini screws
Haomin Cui, Limeng Sun, Dongsheng Zhou, Lianxin Li, Xing Wang, Qinghu Li, Weicheng Xu
Published 2016-02-15
Cite as Chin J Orthop Trauma, 2016, 18(2): 126-132. DOI: 10.3760/cma.j.issn.1671-7600.2016.02.007
Abstract
ObjectiveTo evaluate the short and mid-term effects of fixing comminuted posterior acetabular wall fractures with structural autologous iliac bone graft combined with mini screws.
MethodsFrom January 2010 to January 2014, 29 patients with comminuted posterior acetabular wall fracture were treated by structural autologous iliac bone graf combined with mini screws. They were 21 males and 8 females, with a mean age of 44.2 years (range, from 22 to 58 years) . The mean time form injury to operation was 7.8 days (range, from l to 25 days) . The operations were performed through the Kocher-Langenbeck approach, with the patients in the lying position on the uninjured side. The fragments were reduced and fixed by mini screws and the ischemic ones were removed. Structural autologous iliac bone graft was used to reconstruct the posterior wall of acetabulum before a reconstruction plate was applied to compress and maintain it. The functional outcomes were evaluated by the modified Merle d'Aubigne and Postel clinical grading system at the last follow-ups. The radiographs were graded according to the Matta criteria.
ResultsBy the Matta criteria, 10 cases achieved excellent reduction, 16 good reduction, and 3 poor reduction, giving a good to excellent rate of 89.7%. Of this series, 29 patients were followed up for 31.5 months on average (range, from 12 to 48 months) . By the modified Merle d'Aubigne and Postel criteria, the functional recovery was rated as excellent in 16 cases, good in 9, fair in 3 and poor in one, giving a good to excellent rate of 86.2%. Two cases developed femoral head necrosis according to the magnetic resonance imaging 18 months postoperation. Three patients developed traumatic arthritis two years postoperation. Five patients developed heterotopic ossification postoperation, with no obvious clinical symptoms. Two patient with injury to the sciatic nerve recovered 4 months postoperation.
ConclusionsStructural autologous iliac graft combined with mini screws can reconstruct the integrity and stability of the fractured acetabular posterior wall, avoiding osteonecrosis of the acetabulum. This surgical technique is effective and safe in treatment of comminuted fracture of the acetabular posterior wall.
Key words:
Acetabulum; Fractures, comminuted; Bone nails; Surgical procedures, minimally invasive; Bone transplantation
Contributor Information
Haomin Cui
Department of Orthopaedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
Limeng Sun
Shandong Medical Imaging Research Institute, Jinan 250021, China
Dongsheng Zhou
Department of Orthopaedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
Lianxin Li
Department of Orthopaedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
Xing Wang
Department of Orthopaedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
Qinghu Li
Department of Orthopaedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
Weicheng Xu
Department of Orthopaedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
