Isolated Buttress Plating of Posterior Wall Acetabular Fractures: Is it Sufficient?

Document Type : RESEARCH PAPER


1 Department of Orthopedic Surgery, Harborview Medical Center, University of Washington, Seattle, USA

2 Department of Orthopedic Surgery, Boston University, Boston Medical Center, Boston, USA


Background: Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lag
screws. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoiding
the hardware complications related to hardware placement through the wall fragment. The purpose of this study was
to examine if buttress plating alone, without screw fixation through the wall would be a viable method of treating these
fractures. Our hypothesis was that this technique would not result in loss of reduction.
Methods: Consecutive series of patients with isolated posterior wall acetabular fractures treated by two independent
surgeons at two Level I Trauma centers without screw fixation across the fracture (Boston Medical Center/Harborview
Medical Center).
Results: All 72 fractures treated without a screw through the posterior wall fragment maintained reduction at an
average of 1.6 years post-operatively. For fractures fixed with buttress plating alone, 92 % were reduced within 2 mm
of being anatomic compared to 94 % of fractures that had screws cross the fracture.
Conclusion: The described buttress plating technique without screw fixation in the wall is an acceptable form of
fixation for posterior wall acetabular fractures without the theoretical risk of intra-wall screw fixation.
Level of evidence: III


1. Letournel É􀆵 , Judet R, Elson R. Fractures of the
Acetabulum. 2nd ed., entirely rev. and enl. Berlin; New
York: Springer-Verlag; 1993.
2. Firoozabadi R, Spitler C, Schlepp C, Hamilton B, Agel
J, Tornetta P. Determining stability in posterior wall
acetabular fractures. Journal of orthopaedic trauma.
2015; 29(10):465-9.
3. 3Rockwood CA, Green DP, Bucholz RW. Rockwood
and Green’s Fractures in Adults. 7th ed. Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2010.
4. Browner BD, Jupiter JB, Krettek C, Anderson P.
Skeletal Trauma: Basic science, Management, and
Reconstruction. Fifth ed. Philadelphia, PA: Elsevier/
Saunders; 2015.
5. Moed BR, McMichael JC. Outcomes of posterior wall
fractures of the acetabulum: surgical technique. JBJS.
2008; 90(Supplement_2_Part_1):87-107.
6. Im GI, Shin YW, Song YJ. Fractures to the posterior
wall of the acetabulum managed with screws alone.
Journal of Trauma and Acute Care Surgery. 2005;
7. Stöckle U, Hoffmann R, Nittinger M, Südkamp NP,
Haas NP. Screw fixation of acetabular fractures.
International orthopaedics. 2000; 24(3):143-7.
8. Ebraheim NA, Patil V, Liu J, Sanford CG, Haman
SP. Reconstruction of comminuted posterior wall
fractures using the buttress technique: a review
of 32 fractures. International orthopaedics. 2007;
9. Mast J, Jakob R, Ganz R. Planning and Reduction
Technique in Fracture Surgery. Berlin; New York:
Springer-Verlag; 1989.
10. Saterbak AM, Marsh JL, Nepola JV, Brandser EA,
Turbett T. Clinical failure after posterior wall
acetabular fractures: the influence of initial fracture
patterns. J Orthop Trauma. 2000;14(4):230-237.
11. Goulet JA, Rouleau JP, Mason DJ, Goldstein SA.
Comminuted fractures of the posterior wall of the
acetabulum. A biomechanical evaluation of fixation 
methods. J Bone Joint Surg Am. 1994;76(10):1457-
12. Im G, Chung W. Fractures of the posterior wall of the
acetabulum: treatment using cannulated screws.
Injury. 2004;35(8):782-786.
13. Calkins MS, Zych G, Latta L, Borja FJ, Mnaymneh W.
Computed tomography evaluation of stability in
posterior fracture dislocation of the hip. Clin Orthop
Relat Res. 1988; 227:152-163.
14. Matta JM. Fractures of the acetabulum: accuracy of
reduction and clinical results in patients managed
operatively within three weeks after the injury. J Bone
Joint Surg Am. 1996;78(11):1632-1645.
15. Aho AJ, Isberg UK, Katevuo VK. Acetabular posterior
wall fracture 38 cases followed for 5 years. Acta
Orthop Scand. 1986;57(2):101-105.
16. Bhandari M, Matta J, Ferguson T, Matthys G. Predictors
of clinical and radiological outcome in patients
with fractures of the acetabulum and concomitant
posterior dislocation of the hip. J Bone Joint Surg Br.
17. Chin F, Lo W, Chen T, Chen C, Huang C, Ma H. Fractures
of posterior wall of acetabulum. Arch Orthop Trauma
Surg. 1996;115(5):273-275.
18. Kreder HJ, Rozen N, Borkhoff CM, Laflamme YG, McKee
MD, Schemitsch EH, et al. Determinants of functional
outcome after simple and complex acetabular
fractures involving the posterior wall. J Bone Joint
Surg Br 2006;88(6):776-782.
19. Moed BR, Willson-Carr SE, Watson JT. Results of
operative treatment of fractures of the posterior wall
of the acetabulum. J Bone Joint Surg Am. 2002; 84-A
20. Pantazopoulos T, Nicolopoulos C, Babis GC,
Theodoropoulos T. Surgical treatment of acetabular
posterior wall fractures. Injury. 1993;24(5):319-323.
21. Xin Q, Liu J, Gong Y, Chen Y, Li S, Wei F. Treatment
of posterior wall fractures of acetabulum. Chin J
Traumatol. 2009;12(2):113-117.
22. Firoozabadi R, Hamilton B, Toogood P, Routt MC,
Shearer D. Risk Factors for Conversion to Total Hip
Arthroplasty After Acetabular Fractures Involving the
Posterior Wall. J Orthop Trauma. 2018; 32(12):607-
23. Epstein HC. Posterior fracture-dislocations of the
hip; long-term follow-up. J Bone Joint Surg Am.