Abstract
Fractures of the posterior wall of the acetabulum occur in a frequency of 25 – 30%.
Multifragmentary fractures involving 40 – 50% of the acetabular surface, the quality
of reduction as well as involvement of cartilage and acetabular labrum are considered
to have an impact on the development of a reduced posterior stability of the hip joint.
This results in a shift of the main weight bearing area with development of a posttraumatic
osteoarthritis. In the presented case, a 42-year old male patient was operated on
18 years ago due to a posterior acetabular wall fracture. Retrospectively, one of
the screws was located partially intraarticular. However, the patient was asymptomatic
over the 18-year period. The first consultation was due to unspecific symptoms of
osteoarthritis of the right hip joint especially during flexion and external rotation.
Due to only mild radiological signs of osteoarthritis, we indicated only the removal
of the intraarticular screw. The symptoms
postoperatively switched to a feeling of instability, so a total hip arthroplasty
was performed. Since the operation, the patient is asymptomatic regarding the hip
joint. The intraarticular screw seemed to stabilize the hip joint. This case demonstrates
the importance of a good posterior guidance for the stability of the hip joint on
one hand. On the other hand, it demonstrates the minor stress load of the posterior
acetabular region, especially after fracture of the posterior wall. Therefore, a good
posterior guidance should be one major aim of treatment of posterior acetabular wall
fractures.
Key words
acetabular fracture - microinstability - acetabular labrum - posttraumatic osteoarthritis
