Modified Technique of Percutaneous Posterior Columnar Screw Insertion and Neutralization Plate for Complex Acetabular Fractures

Background: To overcome the complexity of acetabular fractures, several techniques, such as extensive surgical exposure, transtrochanteric osteotomy, and columnar screw fixation, were reported. However, all these techniques have their disadvantages and limitations. We report the surgical results of a modified technique with posterior columnar screw insertion and neutralization plate in a single Kocher-Langenbeck approach for complex acetabular fractures. Methods: We identified 30 patients with 30 acetabular fractures who had been treated by this technique between 1995 and 2004. Demographic data, perioperative results, and complications were all recorded. The detail of surgical procedure was described and illustrated. Results: There were 13 men and 17 women with mean age of 36.4 years (range, 19-66 years). Mean follow-up duration was 49.2 months (range, 24-112 months). All fractures achieved union, and there was no loss reduction and fixation during the follow-up period. There were five complications during hospital stay, including superficial and deep infection and transient sciatic nerve palsy. There was no loss of reduction during follow-up period. Five patients underwent total hip arthroplasty caused by posttraumatic osteoarthritis and preexisting osteoarthritis. The mean Harris Hip Score at 24-month follow-up was 79.7 (median, 92; range, 33-99). Conclusion: This study provided a modified surgical technique of percutaneous insertion of posterior columnar screw that appeared to be safe and reliably hold the column in place for healing.