Surgical treatment of marginal osteochondral impaction in acetabular fractures.

PURPOSE: Clinical and radiological evaluation of the results of the technique of elevation and grafting of osteochondral marginal impaction fragment of posterior wall acetabular fractures.

METHODS

Twenty patients available for this study had fracture acetabulum with marginal impaction fragment. Elevation, reduction and bone graft impaction of the defect were the technique in all cases. Follow-up was at least for 1 year. Evaluation of patient was done clinically by modified Merle d'Aubigné and Postel score and radiologically by Matta's criteria of reduction quality and that of radiological hip evaluation. Ficat criteria for avascular necrosis and Brocker criteria were used for evaluation of heterotopic ossification.

RESULTS

Radiologically, according to the Matta's criteria of reduction quality there were anatomic reduction in 16 patients (80%) and satisfactory reduction in 4 patients (20%). Clinical assessments based on modified Merle d'Aubigné and Postel score include 4 (20%) excellent scores, 12 (80%) good scores, 3 (15%) fair results and poor in one patient who had revision by total hip replacement.

CONCLUSION

Diagnose of marginal impaction fragment preoperatively makes operative technique by elevation, reduction, bone graft packing and fixation mandatory to obtain anatomic reduction and favorable outcome. This technique should be completed before final fixation of the main fracture acetabulum.