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Tricortical iliac crest graft as a salvageable option in the reconstruction of comminuted posterior wall acetabular fractures: our experience from a level 1 trauma centre

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Comminuted fractures of the posterior acetabular wall, pose a significant challenge in the reduction and fixation of the fracture fragments and usually result in dubious functional outcomes. Primary reconstruction of the severely comminuted posterior wall using the autologous tricortical iliac crest graft has shown promising results, especially in fractures not amenable for anatomical reduction and fixation. Thus, the present study analyses the functional and radiological outcomes of severely comminuted posterior wall acetabular fractures, primarily reconstructed with an autologous tricortical iliac crest graft.

Methodology

This is a retrospective study, where all cases of comminuted posterior wall acetabulum fractures treated primarily with reconstruction using ipsilateral autologous tricortical iliac crest graft between January 2011 and November 2018 were included. The data of patients were retrieved from the hospital records and all the patients were assessed clinically and radiologically at the final follow-up.

Results

Fourteen patients (ten males and four females) were operated on with a mean operative time of 160 min (range 125 to 190 min) and a mean blood loss of 410 ml (range 320 ml to 830 ml). At 2 years of follow-up, 11 patients (78.57%) had good to excellent functional outcomes based on the modified Merle d’Aubigne and Postel scoring system. The radiological assessment using Matta’s criteria indicated excellent outcomes in two patients (14.48%), good in six patients (42.85%), fair in six patients (42.85%).

Conclusion

Primary reconstruction of the comminuted posterior wall acetabulum fractures is a potential alternative and salvageable option with favourable outcomes. However, it ought to be considered in severely comminuted fractures where anatomical reduction and internal fixation is not feasible.

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Acknowledgements

We thank Dr Shivanand Gamanagatti, (Professor, Dept. of Radiodiagnosis, AIIMS, New Delhi), Dr Krishna Kumar R. G (Junior Resident, Dept. of Radiodiagnosis, AIIMS, New Delhi) for their valuable time and expertise in analysing the radiographic parameters.

Funding

The authors did not receive support from any organisation for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedics, JPN Apex Trauma Centre, AIIMS , New Delhi, India

    Vijay Sharma, Hemant Bansal, Samarth Mittal, Kamran Farooque & Tushar Nayak

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  1. Vijay Sharma
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  2. Hemant Bansal
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  3. Samarth Mittal
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  4. Kamran Farooque
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  5. Tushar Nayak
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Correspondence to Tushar Nayak.

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Sharma, V., Bansal, H., Mittal, S. et al. Tricortical iliac crest graft as a salvageable option in the reconstruction of comminuted posterior wall acetabular fractures: our experience from a level 1 trauma centre. Arch Orthop Trauma Surg 143, 277–285 (2023). https://doi.org/10.1007/s00402-021-04064-y

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  • DOI: https://doi.org/10.1007/s00402-021-04064-y

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