Vertical T Buttress Plates May Have Better Outcomes for Fixing Posterosuperior Wall Acetabular Fractures with Extension Anterior to the Iliac Pillar

Abstract Background: Posterosuperior wall acetabular fracture is a rare subtype with relatively poor outcomes. Concept of additional superior buttress has been mentioned to offer better stability. Besides, based on our clinical experience, the iliac pillar was an anatomical obstacle that prevents adequate implant fixation in posterosuperior wall fractures. Objectives: We present our clinical series and the use of vertical T buttress plate as a novel method for direct buttressing the posterosuperior wall fragments with extension anterior to the iliac pillar. Materials and Methods: This retrospective case series study reviewed the cases of posterosuperior wall acetabular fractures with fracture extension anterior to the iliac pillar treated with and without the use of vertical T buttress plate. Twelve patients were included at a level-1 trauma center between 2010 and 2021. Radiographic and clinical assessment include reduction quality, radiographic outcomes by Matta, Merle d’Aubigné scores, and complication rates. Results: Twelve patients were included in the study. Five patients were treated with vertical T buttress plates in addition to traditional longitudinal reconstruction plates. Seventy-five percent of patients presented with initial hip dislocation. As for fracture pattern analysis, 50% of patients had marginal impaction and 75% of patients had comminuted fragments. Group treated with vertical T buttress plates had good to excellent results based on Merle d’Aubigné score and radiographic outcome by Matta. As for complications, patients treated with vertical T buttress plates had no total hip arthroplasty conversion and no instability sequela. Four patients (57.1%) in the group without vertical T buttress plate had postoperative instability episodes. Conclusions: For treating acetabular posterosuperior wall fractures with extension anterior to the iliac pillar, using vertical T buttress plates as for buttressing may be a reliable method with better quality of reduction and less postoperative instability condition.