Isolated Buttress Plating of Posterior Wall Acetabular Fractures: Is it Sufficient?

Background: Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lagscrews. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoidingthe hardware complications related to hardware placement through the wall fragment. The purpose of this study wasto examine if buttress plating alone, without screw fixation through the wall would be a viable method of treating thesefractures. Our hypothesis was that this technique would not result in loss of reduction.Methods: Consecutive series of patients with isolated posterior wall acetabular fractures treated by two independentsurgeons at two Level I Trauma centers without screw fixation across the fracture (Boston Medical Center/HarborviewMedical Center).Results: All 72 fractures treated without a screw through the posterior wall fragment maintained reduction at anaverage of 1.6 years post-operatively. For fractures fixed with buttress plating alone, 92 % were reduced within 2 mmof being anatomic compared to 94 % of fractures that had screws cross the fracture.Conclusion: The described buttress plating technique without screw fixation in the wall is an acceptable form offixation for posterior wall acetabular fractures without the theoretical risk of intra-wall screw fixation.Level of evidence: III