Outcomes of posterior wall acetabular fractures with marginal impaction using greater trochanter autografting: A prospective cohort study.

Posterior wall acetabular fractures with marginal impaction pose significant challenges, mainly because of the risk of joint incongruity and the potential for developing post-traumatic arthritis. Restoration of the articular surface and stability are essential to achieve good outcomes. This study investigates the surgical outcomes of posterior wall acetabular fractures with marginal impaction using the Kocher-Langenbeck (KL) approach, buttress plating, and greater trochanter autografting. This prospective cohort study was conducted on 19 patients aged 18-60 years who were treated at a tertiary care center in North India. Fractures were confirmed by radiographic imaging and CT scans. The surgical procedure included articular dis-impaction, void filling with autografts, and fixation with anatomical reconstruction using plates and screws with mean Follow-up period was (mean ± SD) 1.86 ± 0.77 (Ranges:1-3 Years) The outcome was measured using Matta's criteria for radiological evaluation, and functional outcome using the Modified Merle d'Aubigné and Postel Score. Complications were noted, including infection, avascular necrosis (AVN), myositis ossificans, and secondary surgeries. The mean age was 37.58 ± 9.08 years, with a male predominance of 89.5 %. The most common cause was road traffic accidents, at 94.7 %. The most common fracture pattern noted was transverse with posterior wall fracture, with marginal impaction at 47.36 %, followed by isolated posterior wall fractures with marginal impaction at 42.10 %. Anatomical reduction was achieved in 73.7 % of cases, and the radiological outcomes at one year were excellent or good in 78.9 % of cases. Functional scores were excellent or good in 73.65 %. Complications included avascular necrosis with arthritis (21.1 %), myositis ossificans (10.5 %), infection (5.3 %), and conversion to total hip replacement in 10.5 % of cases. Correction of impaction injuries with subchondral autografting and buttress plating via the KL approach provides satisfactory radiologic and functional results. However, associated injuries, particularly head injuries, are associated with poorer recovery outcomes.