Every year approximately 3,400 fractures of the posterior wall of the acetabulum are treated in United States. Most of these are due to injury. Injury is often the mechanism of acetabular posterior wall fracture, resulting from falling, vehicular accidents or a direct impact to the posterior wall by a sharp blunt object and also due to impaction of the object into the acetabulum. The risk factors for fracture of posterior wall of acetabulum are mainly patient factors like age, gender, BMI and the person is less active than others of equal age or weight. Previous infection and history of osteomyelitis seem to be related to the posterior wall of the acetabulum fracture.
Fractures of posterior wall of acetabulum are an extremely rare injuries of the pelvis. The vast majority of patients with an acetabular posterior wall fractures are elderly and present with multiple other injury with multiple fractures to the same joint. There is also an association of posterior wall of acetabulum fracture in patient with Parkinson's disease and hip surgery. The posterior wall of acetabulum is a strong bony buttress which provides stability of acetabulum and serves to protect it from posterior dislocation. However, the mechanism of the injury to the posterior wall of acetabulum can be very complex and multifactorial.
Fracture needs surgical treatment because the patient was admitted to emergency and surgical suite for fracture. X-rays should be taken of the hip to reveal the causative factors.
Patients with fracture of posterior wall of acetabulum should have a full clinical examination and imaging studies, including CT scan, to exclude occult bony, visceral, or pleural injury.
Fracture of posterior wall of acetabulum is common problem in China and can be repaired by open fractures repair. It may be treated by periacetabulum open-wedge plating or internal fixation with porous-coated screw.
Osteopycnosis of posterior wall of acetabulum is commonly seen to be associated with osteoporotic bone fracture or osteoporotic vertebral fracture. However, it is not a typical pathologic finding for fracture of posterior wall of acetabulum. We also found that the fracture of posterior wall of acetabulum in patients with a history of acetabular dysplasia is significantly associated with rickets.
Findings from a recent study may suggest a genetic factor of fracture of posterior wall of acetabulum in families with a history of femoral neck fracture.
The current study shows that TxA can prevent postoperative blood transfusion and its associated morbidity. This effect can be associated with the use of TxA, even for patients already receiving immunosuppressive therapy.
The use of tranexamic acid in hip fracture patients did not reduce the rate of blood loss or transfusion needs at 7 days. A small but significant increase in major bleeding was found in the tranexamic acid group but this was not associated with an increase in blood loss. The tranexamic acid group did not show an increased rate of deep infection or hospital readmission at 8 months post-operatively.
Tranexamic acid is an effective antifibrotic medication for the treatment of fracture fixation of the posterior wall of the acetabulum. Its low side effect profile is especially beneficial for these indications.
A fracture of posterior wall of acetabulum with deformity or avascular necrosis, or both, may not be considered for clinical trials due to its relatively low rate of improvement.
The mean age at the time of presentation for patients with intra-articular acetabular fracture is 61.4 y and that of extra-articular fractures is 44.5 y. The fracture of posterior wall of acetabulum is more common than previously reported (24.9%). In the current study, patients suffering from posterior wall of acetabulum fractures were seen to present more commonly than those in a previous study. It has to be kept in mind that the numbers of people with posterior wall fractures presenting to a hospital is extremely low, thus the mean age of presentation is considerably higher, when compared with the previous study.