Skip to main content

Advertisement

SpringerLink
Log in

Marginal impaction in complex posterior wall acetabular fractures: role of allograft and mid-term results

  • Original Article • PELVIS - FRACTURES
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the functional and radiological outcome of complex posterior wall acetabular fractures with marginal impaction treated with cancellous allograft and internal fixation.

Methods

A total of 16 patients with marginal impaction on pre-operative CT scan, who underwent internal fixation and allograft were analysed. Mean follow-up was 28 months (range 24–42). The mean age was 46.5 years (range 22–71). Out of 16 patients, 8 were AO A1.2- and 8 were AO A1.3-type fractures. Functional evaluation was performed using modified Merle d’Aubigné and Postel scores and radiological evaluation by Matta’s criteria for quality of initial reduction and final outcome.

Results

The quality of reduction was anatomical in 12 patients (75%) and imperfect in 4 patients (25%). The radiological outcome at final follow-up was excellent in 9 (56.25%), good in 5 (31.25%) and fair in 2 patients (12.5%). None of the patients had a secondary loss of reduction at final follow-up. Functional outcome was excellent in 2 (12.5%), good in 8 (50%) and fair in 6 patients (37.5%).

Conclusion

The use of cancellous allograft to fill the bone void provides good mechanical stability without any secondary loss of reduction. This surgical technique seems to be effective and safe in treating comminuted posterior wall fractures with marginal impaction without any donor site complications and other disadvantages of synthetic bone graft materials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer, New York

    Book  Google Scholar 

  2. Brumback RJ, Holt ES, McBride MS et al (1990) Acetabular depression fracture accompanying posterior fracture dislocation of the hip. J Orthop Trauma 4:42–48

    Article  CAS  Google Scholar 

  3. Kreder HJ, Rozen N, Borkhoff CM et al (2006) Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall. J Bone Joint Surg [Br] 88-B:776–782

    Article  Google Scholar 

  4. Giannoudis PV, Tzioupis C, Moed BR (2007) Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint Surg [Br] 89-B:503–509

    Article  Google Scholar 

  5. Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H (2005) Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint Surg [Br] 87-B:2–9

    Article  Google Scholar 

  6. Bhandari M, Matta J, Ferguson T, Matthys G (2006) Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip. J Bone Joint Surg [Br] 88-B:1618–1624

    Article  Google Scholar 

  7. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg [Am] 78-A:1632–1645

    Article  Google Scholar 

  8. Matta JM (1994) Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. Clin Orthop Relat Res 305:10–19

    Article  Google Scholar 

  9. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg [Am] 55:1629–1632

    Article  CAS  Google Scholar 

  10. Kokubo Y, Uchida K, Takeno K et al (2013) (2013): dislocated intra-articular femoral head fracture associated with fracture-dislocation of the hip and acetabulum: report of 12 cases and technical notes on surgical intervention. Eur J Orthop Surg Traumatol 23(5):557–564

    Article  Google Scholar 

  11. Moed BR, Carr SE, Gruson KI et al (2003) Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment. J Bone Joint Surg [Am] 85:512–522

    Article  Google Scholar 

  12. Giannoudis PV, Tzioupis C, Papathanassopoulos A et al (2010) Articular step-off and risk of post-traumatic osteoarthritis: evidence today. Injury 41:986–995

    Article  CAS  Google Scholar 

  13. Brumback RJ, Holt ES, Poka A (1990) Acetabular depression fracture accompanying posterior fracture dislocation of the hip. J Orthop Trauma 4:42–48

    Article  CAS  Google Scholar 

  14. Saad TA et al (2016) Acetabular fractures with marginal impaction. Med J Cairo Univ 84(1):1071–1079

    Google Scholar 

  15. Martins e Souza P, Giordano V et al (2015) Marginal impaction in posterior wall fractures of the acetabulum. Am J Roentgenol 204(4):470–474

    Article  Google Scholar 

  16. Uchida K, Kokubo Y, Yayama T et al (2013) Fracture of the acetabulum: a retrospective review of ninety-one patients treated at a single institution. Eur J Orthop Surg Traumatol 23(2):155–163

    Article  Google Scholar 

  17. Giannoudis PV, Kanakaris NK, Delli Sante E et al (2013) Acetabular fractures with marginal impaction: mid-term results. Bone Joint J 95-B(2):230–238

    Article  CAS  Google Scholar 

  18. Leucht P et al (2013) Comparison of tricalcium phosphate cement and cancellous autograft as bone void filler in acetabular fractures with marginal impaction. Injury 44(7):969–974

    Article  Google Scholar 

  19. Kim et al (2011) Reconstruction of acetabular posterior wall fractures. Clin Orthop Surg 3(2):114–1120

    Article  Google Scholar 

  20. Guerado E, Cano JR, Cruz E (2012) Fractures of the acetabulum in elderly patients: an update. Injury 43(2):33–41

    Article  Google Scholar 

  21. Cornell CN (2004) Hip fractures in the elderly: on the acetabular side. Orthopaedics 27(931–932):17

    Google Scholar 

  22. Vanderschot P (2007) Treatment options of pelvic and acetabular fractures in patients with osteoporotic bone. Injury 38:497–508

    Article  CAS  Google Scholar 

  23. Yun-tong Zhang, Yang Tang, Xue Zhao et al (2013) The use of a structural free iliac crest autograft for the treatment of acetabular fractures. Arch Orthop Trauma Surg 133(6):773–780

    Article  Google Scholar 

  24. Ramesh KS, Sujit KT, Sameer A, Tajir T (2011) Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture. Int Orthop 35:1223–1228

    Article  Google Scholar 

  25. Khira YM, El-Aidy S (2018) Surgical treatment of marginal osteochondral impaction in acetabular fractures. Musculoskelet Surg 102:139

    Article  CAS  Google Scholar 

  26. Almaiman M, Al-Bargi HH, Manson P (2013) Complication of anterior iliac bone graft harvesting in 372 adult patients from May 2006 to May 2011 and a literature review. Craniomaxillofac Trauma Reconstr 6(4):257–266

    Article  Google Scholar 

  27. Dimitriou R, Mataliotakis GI, Angoules AG et al (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury Int J Care Inj 42:S3–S15

    Article  Google Scholar 

  28. Ahlmann E, Patzakis M, Roidis N et al (2002) Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Jt Surg, JBJSOrg A number 5:716–720

    Article  Google Scholar 

  29. Kim DH, Rhim R, Li L, Martha J et al (2009) Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 9:886–892

    Article  Google Scholar 

  30. Schubert T T, Big E, Van Isacker T et al (2012) Analysis of predisposing factors for contamination of bone and tendon allografts. Cell Tissue Bank 13(3):421–429

    Article  Google Scholar 

  31. Kainer MA, Linden JV, Whaley DN et al (2004) Clostridium infections associated with musculoskeletal-tissue allografts. N Engl J Med 350:2564–2571

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Dr. Sunny Parik, MBBS, BSc, MRCS, MSc (sunny.parikh@gmail.com) for his contribution to improving the quality and format of the article.

Funding

No external funding received.

Author information

Authors and Affiliations

  1. Division of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, 641043, India

    Ramesh Perumal, Durga Prasad Valleri, Milkias Tsehaye Gessesse, Dheenadhayalan Jayaramaraju & Shanmuganathan Rajasekaran

Authors
  1. Ramesh Perumal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Durga Prasad Valleri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Milkias Tsehaye Gessesse
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dheenadhayalan Jayaramaraju
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shanmuganathan Rajasekaran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ramesh Perumal.

Ethics declarations

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

Study is approved by an institutional review board.

Informed consent

Informed consent was obtained from all participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perumal, R., Valleri, D.P., Gessesse, M.T. et al. Marginal impaction in complex posterior wall acetabular fractures: role of allograft and mid-term results. Eur J Orthop Surg Traumatol 30, 435–440 (2020). https://doi.org/10.1007/s00590-019-02584-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02584-3

Keywords

Search

Navigation