Technical Trick to Avoid Intra-articular Screw Placement in Posterior Wall Fractures of the Acetabulum

Abstract

Introduction: Screw placement at the posterior margin of the acetabulum while operating for wall fractures requires additional care to avoid articular penetration which can lead to poor functional outcomes. The main objective of this study is to describe a simple four-step surgical guide to avoid intra-articular screw penetration during fixation. Materials and methods: We prospectively analyzed 23 patients (21 males and 2 females) with posterior wall acetabular fractures treated with the described technique in our institution from 2017 to 2019. Of these 23 patients, 8 patients had isolated posterior wall fractures, 9 patients had transverse with posterior wall fracture, and 6 patients had posterior wall and column fractures. Radiograph Judet views and computerized tomography (CT) scan were done in all the patients to check for intra-articular screws on the second postoperative day. Results: By radiograph and CT scan in all the patients, there was no intra-articular screw penetration noticed following acetabular fracture fixation. All the 23 patients in our study had a good functional outcome with Merle D’aubigne score of ≥ 18 in 12 patients and ≥ 10 in 11 patients. Conclusion: Good knowledge of the osseous anatomy of the pelvis is essential to prevent intra-articular screw placement during fixation of acetabular fractures. Our four-step surgical tip to insert periacetabular screws under direct vision helps prevent intra-articular screw placement during acetabular fracture fixation by posterior approach. Besides, this technique is easily reproducible and helps to minimize intraoperative radiation time.