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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