A 55-year-old woman sustains a posterior hip dislocation with posterior wall acetabular fracture. After closed reduction, CT pelvis reveals a posterior wall fragment involving 40% of the posterior wall with an intra-articular osteochondral fragment. The appropriate management is:
- A Bed rest and skeletal traction for 6 weeks — fragment will remodel
- B Total hip arthroplasty as primary treatment
- C Non-operative management with early mobilization — >25% posterior wall is not a surgical threshold
- D ORIF via Kocher-Langenbeck approach: fixation of posterior wall fragment with removal of intra-articular loose body ✓
Explanation
Surgical indications for posterior wall acetabular fractures after hip reduction: posterior wall fragment >20–25% of articular surface (predicts instability), marginal impaction, intra-articular loose fragments, or inability to achieve stable concentric reduction. This patient has 40% posterior wall involvement AND an intra-articular fragment — both absolute indications for ORIF via the Kocher-Langenbeck approach, which provides excellent posterior wall exposure. The loose body must be removed to prevent cartilage damage. Non-operative management risks re-dislocation and posttraumatic arthritis. THR is reserved for severe comminution in elderly patients or failed ORIF with arthrosis.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.