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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 4, 503-509.
doi: 10.1302/0301-620X.89B4.18380  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum

P. V. Giannoudis, BSc, MD, EEC(Orth), Professor1; C. Tzioupis, MD, Trauma Fellow1; and B. R. Moed, MD, Professor and Chairman2

1 Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK.
2 Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 7th Floor, Desloge Towers, St Louis, Missouri 63110, USA.

Correspondence should be sent to Professor P. V. Giannoudis; e-mail: pgiannoudi{at}aol.com

Our aim was to evaluate the efficacy of a two-level reconstruction technique using subchondral miniscrews for the stabilisation of comminuted posterior-wall marginal acetabular fragments before applying lag screws and a buttress plate to the main overlying posterior fragment. Between 1995 and 2003, 29 consecutive patients with acute comminuted displaced posterior-wall fractures of the acetabulum were treated operatively using this technique.

The quality of reduction measured from three standard plain radiographs was graded as anatomical in all 29 hips. The clinical outcome at a mean follow-up of 35 months (24 to 90) was considered to be excellent in five patients (17%), very good in 16 (55%), good in six (21%) and poor in two (7%). The use of the two-level reconstruction technique appears to provide stable fixation and is associated with favourable results in terms of the incidence of post-traumatic osteoarthritis and the clinical outcome. However, poor results may occur in patients over the age of 55 years.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General