Firoozabadi Reza, Yu Chen Eric, Elhaddad Moamen, Tornetta Iii Paul
Department of Orthopedic Surgery, Harborview Medical Center, University of Washington, Seattle, USA.
Department of Orthopedic Surgery, Boston University, Boston Medical Center, Boston, USA.
Arch Bone Jt Surg. 2020 Jul;8(4):511-518. doi: 10.22038/abjs.2020.42128.2167.
Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lag screws. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoiding the hardware complications related to hardware placement through the wall fragment. The purpose of this study was to examine if buttress plating alone, without screw fixation through the wall would be a viable method of treating these fractures. Our hypothesis was that this technique would not result in loss of reduction.
Consecutive series of patients with isolated posterior wall acetabular fractures treated by two independent surgeons at two Level I Trauma centers without screw fixation across the fracture (Boston Medical Center/Harborview Medical Center).
All 72 fractures treated without a screw through the posterior wall fragment maintained reduction at an average of 1.6 years post-operatively. For fractures fixed with buttress plating alone, 92 % were reduced within 2 mm of being anatomic compared to 94 % of fractures that had screws cross the fracture.
The described buttress plating technique without screw fixation in the wall is an acceptable form of fixation for posterior wall acetabular fractures without the theoretical risk of intra-wall screw fixation.
髋臼后壁骨折的传统固定方法采用钢板和拉力螺钉。然而，单纯使用支撑钢板固定后壁骨折具有潜在优势，可避免因通过骨折块置入内固定物而引发的相关并发症。本研究旨在探讨单纯使用支撑钢板而不通过骨折块进行螺钉固定是否是治疗这些骨折的可行方法。我们的假设是该技术不会导致复位丢失。
由两位独立的外科医生在两个一级创伤中心（波士顿医疗中心/哈博维尤医疗中心）对一系列孤立性髋臼后壁骨折患者进行治疗，骨折处不进行螺钉固定。
所有72例未通过后壁骨折块置入螺钉治疗的骨折在术后平均1.6年时均维持了复位。对于单纯采用支撑钢板固定的骨折，92%的骨折复位后与解剖复位相差在2mm以内，而采用螺钉穿过骨折处固定的骨折这一比例为94%。
所描述的不通过骨折块进行螺钉固定的支撑钢板技术是髋臼后壁骨折可接受的固定方式，不存在理论上的骨折块内螺钉固定风险。
