Late reconstruction of posterior acetabular wall fractures using iliac crest.

BACKGROUND

Reconstructing late posterior acetabular wall fractures is challenging. This study evaluates the use of the iliac crest strut graft for posterior acetabular wall reconstruction.

METHODS

From 1990 to 2004, seven patients (five males and two females) with traumatic posterior acetabular wall defects were reconstructed using autogenous iliac crest strut grafts. The mean age of the patients was 31 years. The mean time from injury to reconstruction was 6.4 months. The clinical (modified Merle d'Aubigné-Postel score) and radiologic evaluation (Matta score) were recorded at the final follow-up.

RESULTS

The mean duration of follow-up was 76 months. On the basis of the modified Merle d'Aubigné-Postel scoring system, the clinical outcomes at final follow-up were as follows: excellent for a pediatric patient; good for three adult patients without posttraumatic osteoarthritis of the hip at the time of reconstruction; and poor for three other adult patients with posttraumatic osteoarthritis of the hip at the time of reconstruction. Radiologic grading at the final follow-up was good in the pediatric patient; fair in three adult patients without posttraumatic osteoarthritis of the hip; and poor in three other patients with posttraumatic osteoarthritis of the hip.

CONCLUSIONS

The reconstruction of the posterior acetabular wall defects using an iliac crest strut graft is a noteworthy technique for late posterior acetabular wall fracture. The technique may be an option for pediatric patients or adults without posttraumatic osteoarthritis of the hip at the time of reconstruction. However, it is not recommended for adult patients with posttraumatic osteoarthritis of the hip. In this case, total hip arthroplasty is a better choice.

LEVEL OF EVIDENCE

IV, therapeutic study.