{
    "abstract": "Posterior-wall acetabular fractures have been reported to be associated with marginal impaction characteristics in approximately 16% to 38% of cases\nThe procedure is performed with the patient under general anesthesia, placed under traction in either the prone or lateral position with use of a radiolucent flat-top fracture table and fluoroscopic guidance. The Kocher-Langenbeck approach is utilized. The big posterior wall fracture is identified and reflected in order to visualize the joint surface. Subsequently, traction is applied to facilitate visualization of the marginal impaction area(s). With use of an osteotome, the impacted fragments are disimpacted and elevated. The femoral head is utilized as a template for accurate reduction of the impacted fragments to the acetabular joint surface. The resultant subchondral void is assessed and may be grafted with use of a variety of bone graft materials. The 2-level reconstruction technique may also be considered when the surgeon desires to optimize stability of the impacted fragments and maintain anatomical reduction. The big posterior wall fragment is reduced and fixed with use of the standard posterior-wall reconstruction technique. Finally, irrigation and wound closure in layers is performed.\nTreatment alternatives include either delayed or acute primary total hip arthroplasty in elderly patients >70 years old.\nPreoperative identification of the marginal impaction is critical because articular incongruency leads to the development of early posttraumatic osteoarthritis. Achieving joint congruency is especially important in the young population in order to avoid an otherwise unnecessary early total hip arthroplasty.\nExpected radiographic outcomes are excellent or good in 82% of cases, as measured with use of the Matta radiographic score\nJoint irrigation is crucial in order to clarify the details of the fragmentation and facilitate removal of debris. Impacted articular cartilage fragments are often rotated and face away from the femoral head. Utilize osteotomes to elevate the impacted area, taking care to mobilize adequate subchondral bone and the accompanying cartilage in case the 2-level reconstruction technique is needed and can be successfully applied. Utilize the femoral head as a template after traction is released to facilitate anatomical reduction. A 1.6-mm Kirschner wire should be available in case it is needed to temporarily stabilize the impacted fragments. Avoid overstuffing the void with bone graft because this may subsequently hinder successful reduction of the posterior wall fragment.\nCT = computed tomographyAP = anteroposteriorK wire = Kirschner wirePDS = polydioxanone sutureAVN = avascular necrosis.",
    "authors": [
        {
            "affiliation": "Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom.",
            "firstname": "George D",
            "initials": "GD",
            "lastname": "Chloros"
        },
        {
            "affiliation": "Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom.",
            "firstname": "Ahmed",
            "initials": "A",
            "lastname": "Ali"
        },
        {
            "affiliation": "Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom.",
            "firstname": "Nikolaos K",
            "initials": "NK",
            "lastname": "Kanakaris"
        },
        {
            "affiliation": "Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom.\nNIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.",
            "firstname": "Peter V",
            "initials": "PV",
            "lastname": "Giannoudis"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2022 by The Journal of Bone and Joint Surgery, Incorporated.",
    "doi": "10.2106/JBJS.ST.21.00004",
    "journal": "JBJS essential surgical techniques",
    "keywords": [],
    "methods": null,
    "publication_date": "2022-06-14",
    "pubmed_id": "35692720\n17463120\n23365034\n31679048",
    "results": null,
    "title": "Surgical Treatment of Marginal Impaction Injuries of The Acetabulum Associated with Posterior Wall Fractures.",
    "xml": "<Element 'PubmedArticle' at 0x788503dc2200>"
}