Isolated acetabular anterior wall fractures: fracture patterns, fixation methods and a new proposed classification system for a rare injury.

BACKGROUND

Isolated anterior wall acetabulum fracture (AWF) represents a rare injury. There is a paucity of information available about this fracture and no classification has been proposed so far. The aim of this study was to analyse the various possible fracture patterns, related treatment approaches and to develop a new classification system.

METHODS

Common search engines were systematically searched, according to the PRISMA guidelines. Data relating to the studies that reported surgical approaches and results about isolated AW fractures were included. Data quality was also assessed. We topographically subdivided the fractures, according to the percentage of the anterior wall involved, location of the fracture, and the degree of comminution. The mean follow-up was 38.8 months (6-240).

RESULTS

17 papers were eligible for this study. The ilio-inguinal (ILI) approach was the most used one (58.2 %). Different reconstruction techniques were deployed. Anatomical reduction was obtained in 46.6 % of the cases. 3 patients required hip prosthesis within 18 months. Based on the evidence gathered the anterior wall was divided into 3 segments (proximal, (P) middle (M) and distal (D)1/3 segment. Based on the area of involvement in each zone was also divided into Type I < 25 %; Type II 25-50 % and Type III >50 %. Comminution (C) was also assigned if present in any of the 3 zones.

CONCLUSION

Isolated anterior wall acetabulum fracture is an uncommon injury. The IIL approach was the most used for fixation. A new classification system was developed to guide surgical approach and fixation techniques.