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Associated 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;
  • 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