A 45-year-old man sustains a posterior dislocation of the hip with an acetabular fracture. On CT scan, a posterior wall fragment involving 40% of the articular surface is identified. The management is:
- A Closed reduction under anaesthesia and 6 weeks traction
- B Open reduction and internal fixation of the posterior wall fragment via Kocher-Langenbeck approach ✓
- C Closed reduction followed by observation if concentric reduction achieved
- D Immediate total hip arthroplasty
Explanation
Posterior wall acetabular fractures involving >25-40% of the posterior articular surface are unstable and require ORIF to restore hip stability and articular congruity. Instability testing under fluoroscopy after closed reduction helps confirm if >50% of the wall is deficient. The Kocher-Langenbeck (posterior) approach provides excellent exposure for posterior wall and column fixation. Closed reduction and traction may be used as a temporary measure but cannot maintain reduction of a large unstable posterior wall fragment. ORIF within 2-3 weeks provides best articular reduction outcomes.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.