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SYMPOSIUM Table of Contents   
Year : 2002  |  Volume : 36  |  Issue : 1  |  Page : 25-26
Posterior column fractures


Sri Ramachandra Medical College And Research Institute, Chennai, India

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How to cite this article:
Marthandam S. Posterior column fractures. Indian J Orthop 2002;36:25-6

How to cite this URL:
Marthandam S. Posterior column fractures. Indian J Orthop [serial online] 2002 [cited 2019 Dec 14];36:25-6. Available from: http://www.ijoonline.com/text.asp?2002/36/1/25/35920
Posterior column fractures are commonly associated with a posterior wall fragments and posterior dislocation of hip. Although fractures of the posterior column include the most accessible and readily stabilized of all acetabular fractures, the treatment of comminuted fractures is often associated with several possible complications, including osteonecrosis of the femoral head, post traumatic osteoarthrosis, resorption of the fragments of the wall, and loss of fixation of the wall.

We recommend the comprehensive classification by Marvin Tile. [1] The description of posterior column fractures includes posterior wall fractures.

Type A: Partial Articular Fractures

A1: posterior wall fractures

A2: posterior column fractures

Surgical management of posterior wall and posterior column fractures [1],[2]

Surgical approach

Posterior Kocher-Langenbeck-osteotomy of the greater trochenter is helpful if more visualization is required

Position: Lateral decubitus with hip in extension and knee in flexion to relax the sciatic nerve.

Reduction Technique for posterior wall fragment: The posterior wall fragment with the attached soft tissue must be turned back, like the cover of a book, exposing the underlying femoral head.

It is imperative that the edges of the fracture, particularly at the acetabular rim, be precisely cleaned to ensure anatomic reduction. Reduction is obtained by gentle longitudinal traction along the femoral neck and all marginally impacted fragments can be wedged into place, which guarantees reduction along its posterior column line and particularly at fracture line areas.

Reduction techniques posterior column fractures: During reduction, rotation of the posterior wall fragment must be corrected. The simplest way to do this is to place into the ischial tuberosity a 5 mm Schanz screw on a T handle [1] or some form of reduction pin to act as a handle for rotational control. With this in place and with exposure through the greater and lesser notch by removal of the sacrospinous ligaments either by blunt or sharp dissection or osteotomy of the ischial spine, the medial fracture line can be palpated inside the pelvis, along the quadrilateral plate, to determine the adequacy of the reduction. This may also be accomplished by externally lifting and rotating the posterior column fragment.

This reduction may be further facilitated by using the specially devised pointed reduction clamps. This reduction must also be confirmed by inspecting inside the joint on the posterior column and by palpating the medial wall. Occasionally, using pelvic reduction forceps with screws affixed to the posterior column above the ischial tuberosity and to the superior portion of the iliac wing above the acetabulum also facilitates reduction.

For associated posterior wall and the posterior column fractures (A1) reduction of the posterior column component should be carried out first. This allows for articular visualization of the reduction and makes it easier to control the posterior column and apply fixation.

The hamstring muscles act as the major deforming force of the posterior column because of their origin from the ischial tuberosity. It is advisable to reduce such fractures with the hip extended and the knee flexed 90 degree.

Fixation technique for posterior wall: Predrilling the glide holes through the unreduced fragment, ensures that the screws stay out of the joint. [1] A well-contoured buttress plate neutralizes the forces directed onto this posterior wall and tends to prevent redisplacement. It is anchored at the ischial tuberosity by at least two screws, and in the hard bone superior to the acetabulum.

Fixation technique for posterior column [1],[2]

The posterior column should be fixed with lag screws, and is buttressed by a 3.5 mm reconstruction plate from the ischial tuberosity to the superior aspect of the acetabulum.[Figure 1],[Figure 2]

 
   References Top

1.Tile M. Fractures of Pelvis and acetabulum. Baltimore; Williams & Wilkins. 1984.  Back to cited text no. 1    
2.Judet R, Judet J, Letourne E. Fractures of acetabulum: Classification & surgical approaches for open reduction. J Bone Joint Surg 1964; 46 A (8): 1615 - 1647.  Back to cited text no. 2    

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Correspondence Address:
SSK Marthandam
Sri Ramachandra Medical College and Research Institute, Porur, Chennai 600116
India
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Source of Support: None, Conflict of Interest: None


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  [Figure 1], [Figure 2]



 

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