| Objective: To investigate the radiographic and clinical results of acetabular fracture involving posterior wall , and analyze the relation between the radiographic and clinical results,the factors effect on clinical results and independently dangerous factors.Methods: From February 2000 to March 2006, a total of 64 cases with acetabular fracture involving posterior wall treated with open reduction and internal fixation were followed up. Of 64 fractures, there were 42 isolated posterior wall fractures, 14 posterior column and posterior wall fractures, 8 transverse and posterior wall fractures. The contents followed up included:1,Radiographic studies: According to Matta′X-ray reduction criterion,X-ray evaluation standard and Brooker classification, postoperative fracture reduction,radiographic results and heterotopic ossification were evaluated. 2,Clinical results evaluation:VAS,the modified Merle d′Aubignéand Postel evaluation standard were used to determined the long-term effect of operation. 3,Investigation of factors effected on clinical results: Age,gender,BMI,the time to reduction of hip dislocation after injury,the time to surgery after injury,types of fractures,associated marginal impaction,the degree of fracture comminution,the quality of reduction and heterotopic ossification.Results: All the cases were followed up from 13 to 92 months. The average follow-up was 44.6±4.2 months. According to Matta′X-ray reduction criterion, reduction was anatomic in 58 cases, imperfect in 5 but poor in 1. According to radiographic standard assessment,52 cases were excellent,4 good, 5 fair and 3 poor. According to the modified Merle d′Aubignéand Postel evaluation standard, 54 cases were excellent,3 good, 4 fair and 3 poor. Excellent and good rates for clinical results and radiographic results were 87.50% and 89.06% respectively. Excellent and good rates for clinical results in the group of isolated posterior wall fracture and in the group of complex fracture involving posterior wall fracture were 97.62% and 72.72% respectively; Excellent and good rates for clinical results in anatomical and nonanatomica1 reduction group were 94.83% and 33.33% respectively; As the time to reduction of hip dislocation after injury, Excellent and good rates for clinical results in the group of <24 h and in the group of≥24 h were 94.87% and 20.00% respectively; As the time to surgery after injury, excellent and good rates for clinical results in the group of <3w and in the group of≥3w were 94.83% and 33.33% respectively; Excellent and good rates for clinical results in the group of comminuted fracture and in the group of non-comminuted fracture were 77.78% and 97.30% respectively; Excellent and good rates for clinical results in the group of <50 and in the group of≥50 were 98.15% and 40.0% respectively; Excellent and good rates for clinical results in the group of severe heterotopic ossification and in the group of mild heterotopic ossification were 0% and 87.50% respectively. The differences between each factor group and clinical results were significant (P<0.05). Sex,BMI,associated marginal impaction had no significant effects on clinical results (P>0.05). As affected factors were analyzed by multivariate Logistic regression analysis, the time to surgery after injury,the quality of reduction,severe heterotopic ossification were independently dangerous factors affected clinical results.Conclusion 1 Anatomical reduction and stable internal fixation are key to obtaining satisfactory results in the management of such fractures. 2 The time to reduction of hip dislocation after injury,the time to surgery after injury,types of fractures,the degree of fracture comminution,the quality of reduction,severe heterotopic ossification are main risk factors affecting clinical results; the time to surgery after injury,the quality of reduction and severe heterotopic ossification are independently dangerous factors affected clinical results. Avoiding the unfavorable influences of the factors will improve the clinical results.
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