Posterior wall acetabular fracture

Case contributed by Dr Francis Deng

Presentation

Restrained front seat passenger in motor vehicle collision at 25 miles per hour.

Patient Data

Age: 70 years
Gender: Male
  • mildly comminuted fracture of the right acetabulum posterior wall with substantial involvement of the acetabular roof and posterior displacement of the dominant fragment
  • mild impaction fracture of the right femoral head posteroinferior surface
  • small (9 mm) linear incarcerated fracture fragment in the posteroinferior joint space
X-ray
  • fracture involving the right acetabular posterior rim and roof
  • subtle flattening of the inferior medial surface of the right femoral head
  • intact anterior acetabular rim, ilioischial line, iliopectineal line, obturator ring, and sacroiliac joint on both sides
  • excreted contrast media in the urinary bladder

Case Discussion

According to the Judet-Letournel classification of acetabular fractures, this is an isolated posterior wall fracture pattern, which is commonly seen with motor vehicle accidents. The mechanism of injury is that on rapid deceleration, the occupant's knee hits the dashboard, transmitting force up the femur and into the posterior acetabular wall.

Noting the displacement, size, and involvement of the weight-bearing dome, surgical treatment was indicated in this case because the defect renders the hip unstable.

On examination under anesthesia, the hip was easily dislocated with flexion, internal rotation, and adduction. Via a posterior approach, open reduction and internal fixation was performed using a plate and screw construct along the course of the posterior column of the acetabulum.

At one year follow-up, the patient had recovered and was ambulating independently. No hardware complication was evident on imaging.

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Case information

rID: 73301
Published: 6th Jan 2020
Last edited: 6th Jan 2020
Inclusion in quiz mode: Included
Institution: Massachusetts General Hospital

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