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9Posterior wall: reduction and fixation

Reduction

Commonly, the associated both column fracture requiring reduction via the extended iliofemoral approach has an associated posterior wall fracture. The morphology and location of the posterior wall components are highly variable as shown in these three examples. Very commonly, this fragment is located in between the fracture lines of the anterior and posterior column fragments.

It is important that the fragment remains anatomically positioned between posterior and anterior columns, without gaps or step offs of the joint surface.

The sequence of reduction of the posterior wall fragments will vary based on its morphology and spacial relationship to the columns. In cases of very cranial wall fragments (A), the posterior wall may be reduced to the anterior column prior to reduction and fixation of the posterior column. In other cases, if the wall fragment is distal for example (B), the posterior wall may be reduced after the posterior and anterior columns have been reconstructed.