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