Non-fixation For Posterior Wall Fragment In Both-column Acetabular Fractures With Posterior Wall Fragment:A Retrospective Study

Purpose: To evaluate the clinical outcomes of patients with non-fixation posterior wall fragment in the acetabular both-column fracture combined with posterior wall fractures.Methods: We retrospectively analyzed the data of 21 cases of acetabular both-column fractures with posterior wall fragment in our hospital from October 2014 to October 2017.There are 16 males and 5 females;the average age is 46.95±12.71(26-71)years old;the injured method: 5 people in motor vehicle accident,16 people in falling from a height;injured part: 8(38.1%)on the left acetabulum,13 on the right acetabulum(61.9%).The ISS score was 13.09 ± 4.98.The operative time,intraoperative blood loss and the postoperative complications were recorded and analyzed.Matta criteria were used to evaluate reduction levels.The Modified Postel Merle D'Aubigne score was used to evaluate the hip functional outcomes.Radiographs were analyzed for traumatic arthritis and HO at the latest follow up.Results: 21 patients were followed up and 2 patients were lost to follow-up.Average follow-up time was 25.22 ± 10.77(12-49)months.All patients had fracture healing and no deformity.The average surgical time was 169.52±29.70 mins,and the operation blood loss was 757.14±326.45 ml.The quality of the reduction was evaluated according to the Matta scoring standard.The quality of the reduction was excellent in 6(28.57%)cases,good in 12(57.14%)cases,and poor in 3(14.29%)cases.Hip function was evaluated according to the modified Merled'Aubigné and Postel scoring system,including excellent in 5 cases,imperfect in 12 cases,fair in 2 cases,and poor in 2 cases.The excellent and good rate was 80.95%.3(12.28%)patients had deep venous thrombosis of the lower extremity,no pulmonary embolism;1(4.8%)patients developed wound infection;2(9.5%)had lateral femoral nerve injury;no patients developed traumatic arthritis,avascular necrosis of the femoral head and heterotopic ossification and reoperation.Conclusion: For patients of acetabular both-column fracture combined with posterior wall fragment,if the posterior wall fragment is intact and the both-column fracture is satisfactorily reduced and fixed,the posterior wall fragment may not be fixed.