Posterior wall acetabular fractures: Update on surgical indications, fixation techniques and outcome measurements

Posterior wall acetabular fractures are the most common fracture patterns identified in most consecutive series comprising approximately 20-25% of all acetabular fractures. The familiar presentation and simple appearance of these fractures on plain radiographs preoperatively and postoperatively mask the complex bony and soft-tissue injury involved. Recent studies have continued to focus on the assessment of fracture size and hip stability as operative indications, the type of fixation required for optimal stability, augmentation of residual fracture defects and functional assessment of patient outcomes. Clinical outcomes have fallen short of the excellent radiographic outcomes reported in most series. Currently utilized outcome instruments identify general domains of postoperative functional loss that preclude return to preinjury function, but these tools inadequately assess patients' specific deficits. As the average age and weight of the population increases, posterior wall fractures in elderly and morbidly obese patients become a growing challenge. These patients incur more complications and higher rates of failure using standard operative techniques. Surgeons must consider alternatives to open reduction and internal fixation, especially in these subpopulations.