Spectrum, management strategies, and outcomes of isolated posterior wall acetabular fractures: A retrospective study of 129 patients.

BACKGROUND

Posterior wall fractures are the most common acetabular fracture pattern and are associated with a wide spectrum of injury severity, hip instability, and complications. Management depends on fracture morphology and joint stability, yet factors influencing outcomes and complications remain incompletely defined.

METHODS

This retrospective study included 129 patients with isolated posterior wall acetabular fractures treated between 2012 and 2022. Demographic data, fracture patterns, management strategies, and complications were reviewed. Radiological outcomes were assessed using Matta's criteria, and functional outcomes were evaluated using the EuroQol-5D questionnaire.

RESULTS

The cohort comprised predominantly males (91%), with a mean age of 42.4 years. Fracture patterns included simple posterior wall fractures (62A1.1) in 58 patients, multifragmentary fractures (62A1.2) in 54 patients, and fractures with marginal impaction in 17 patients. Surgical management was required in 123 patients, while 6 were treated non-operatively. Complications occurred in 25 patients. Multifragmentary fractures and associated hip dislocation were significantly associated with higher rates of avascular necrosis (p = 0.023) and post-traumatic arthritis (p = 0.0137). Radiological outcomes were excellent or good in 87.6% of patients, and the majority reported no or only slight problems on the EuroQol-5D questionnaire.

CONCLUSION

Dynamic stress examination helped identify hip instability in selected posterior wall fractures, including those with less than 20% wall involvement. Fracture complexity was associated with worse outcomes and higher complication rates, particularly avascular necrosis and post-traumatic arthritis.