Abstract
The management of combined anterior column and posterior wall acetabular fractures requires dual surgical approaches, which may increase operative morbidity. This study evaluated the efficacy and safety of posterior wall lag screw fixation using the anterior intrapelvic (AIP) approach, eliminating the need for a secondary posterior incision. Patients with concomitant anterior column and posterior wall fractures were included in the study by collecting acetabular fractures surgically treated via AIP approach between 2014 and 2019. Posterior wall fractures were subsequently stabilized with lag screws inserted using the same anterior approach, without additional posterior exposure. Patients who had <12 months follow-up data were excluded. The reduction quality was assessed using the Matta radiographic criteria. Functional outcomes were evaluated using the Harris Hip Score and the modified Merle d'Aubigné and Postel scoring system. Postoperative short- and long-term complications were also evaluated. At the 12-month postoperative follow-up, radiographic evaluations confirmed complete fracture union in all patients, without any loss of reduction or signs of posterior instability. According to Matta radiographic criteria, anatomic reduction was achieved in 4 patients (33.3%), good reduction in 6 patients (50%), and poor reduction in 2 patients (16.6%). Functional outcomes showed a mean Harris Hip Score of 87.0 ± 9.3, with 7 patients (58.3%) rated as "excellent," 2 (16.6%) as "good," and 3 (25%) as "fair." The mean modified Merle d'Aubigné and Postel scoring system was 16.41 ± 1.5, with 4 patients (33.3%) graded as "excellent," 6 (50%) as "good," and 2 (16.6%) as "fair." The mean hospital stay was 8.4 ± 4.3 days (range: 5-18), with a mean operative time of 115.8 ± 36 minutes (range: 90-225) and mean intraoperative blood loss of 580 ± 555 mL (range: 250-2300). The AIP approach with posterior wall lag screw fixation provides a viable solution for complex acetabular fractures, delivering favorable clinical and radiological results while avoiding posterior incisions. Preoperative planning and precise screw placement are critical for success. Further studies are recommended to refine patient selection and improve surgical protocols.