Executive Editor: Richard Buckley

Authors: Tania Ferguson, Daren Forward

Acetabulum - Posterior column and wall

back to skeleton

Glossary

General considerations

ORIF is the optimal operative treatment for most fractures. 

The severity of the wall fragment in this combined fracture will likely dominate the decision making, in particular the size of the fragment and the degree of comminution.

The outcome is often surprisingly poor.

Consider total hip replacement for severe arthritis and possibly for severe osteoporosis.

Surgery is urgent for:

  • Irreducible dislocation
  • Increasing sciatic nerve deficit
  • Hip joint incongruence with risk of femoral head damage
Nonoperative treatment
Main indication Skill Equipment
Stable hip with a concentric reduction, no intraarticular fragments identified on CT with a small posterior wall fragment in an elderly patient Highly experienced and skilled surgeon Basic equipment only

Contraindications

  • Irreducible dislocation
  • Progressive sciatic nerve deficit
  • Large posterior wall fragments

Advantages

  • Avoidance of risk of surgery
  • Preservation of the soft tissue approach for later hip replacement

Disadvantages

  • Risk of late instability
ORIF through Kocher-Langenbeck
Main indication Skill Equipment
Approach of choice, most suited to smaller, more inferior fragment of the posterior wall Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Variations of this approach include the Gibson approach and the use of a trochanter osteotomy extension. As the wall fragment increases in size and extends superiorly, a trochanter osteotomy extension may become more favorable.

Advantages for approach

  • Smaller, simpler and less demanding surgery

Disadvantages

  • May not allow enough visualization and reduction of larger wall fragments
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2017-11-27