A 28-year-old man sustains an isolated posterior wall acetabular fracture in a road traffic accident. CT scan shows a single fragment involving 15% of the posterior wall with 1 mm of displacement. Post-reduction hip examination shows the joint is stable through a full range of motion. What is the recommended management?
- A Urgent total hip arthroplasty
- B Non-operative management with protected weight bearing ✓
- C Open reduction and internal fixation via Kocher-Langenbeck approach
- D Percutaneous screw fixation under fluoroscopy
Correct answer: B. Non-operative management with protected weight bearing
Explanation
Non-operative management is indicated for posterior wall fractures with <2 mm of displacement, <20-25% wall involvement, and a stable hip on examination under anesthesia. This fracture meets all three criteria. ORIF is indicated for displaced fractures (>2 mm), large fragments (>25% wall), hip instability, or intra-articular loose fragments. The 15% involvement and 1 mm displacement fall within acceptable non-operative limits.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.