Nonoperative treatment of the posterior column fracture is unusual. Most posterior column fractures are displaced, and any displacement requires reduction and fixation.
Surgery is urgent for:
- Irreducible dislocation
- Increasing sciatic nerve deficit
- Hip joint incongruity with risk of femoral head damage
ORIF is the optimal operative treatment for most fractures. For severe arthrosis or osteoporosis, total joint replacement should be considered.
|Undisplaced fractures (occur rarely)|
- Avoidance of risks of surgery
- Control radiographs necessary in the first two weeks
|ORIF through Kocher-Langenbeck|
|All displaced posterior column fractures|
Any displacement of the posterior column requires reduction and fixation.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|