The Hip: Preservation, Replacement and Revision

Associatted Transverse and Posterior Wall Fractures

- Discussion:
    - use similar stratedgy as one would use for posterior wall frx w/ distraction of the femoral head, removal of all intra-articular
               fragments & correction of femoral head depressions;

- Approach:
    - use Kocher Langenbeck approach w/ prone positioning of patient, unless frx is remote, in which case, use extended iliofemoral approach;
    - femoral head is distracted and incarcerated fragments are removed;

- Reduction & Fixation:
    - Reduction of transverse fracture is carried out first;
         - fixation of transverse frx with lag screws into superior ramus;
         - long cancellous screw is transfixed into superior pubic ramus;
    - it may not possible to obtain initial fixatoin w/ lag screw;
         - in this case, begin fixation w/ plate along greater sciatic notch;
    - posterior wall frx is adressed;
         - first remove of osteocartilaginous fragments;
         - correction of femoral head depressions;
         - posterior wall frx is reduced & fixed with lag screws;
         - curved plate is then applied from the ischial tuberosity to inferior ilium, which bridges the transverse and posterior wall frx

A Surgical Approach Algorithm for Transverse Posterior Wall Fractures Aids in Reduction Quality

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 3, 2019 2:34 pm