[Objective]To compare the clinical results of open reduction and internal fixation(ORIF)of acetabular fractures involving the posterior wall by the direct posterior approach(DPA)versus Kocher Langenbeck(K-L)approaches.[Methods]A retrospective analysis was conducted on 43 patients who underwent open reduction and internal fixation for acetabular fractures involving the posterior wall from January 2015 to June 2022.Of them,19 patients underwent ORIF through DPA approach,while other 24 patients were through the K-L ap-proach.The documents of perioperative period,follow-up,and images were compared between the two groups.[Results]The DPA group showed significantly better than the K-L group in terms of surgical time[(83.9±13.9)min vs(102.0±20.9)min,P=0.002],incision length[(9.8±1.2)cm vs(16.0±1.5)cm,P＜0.001],intraoperative blood loss[(267.4±56.6)ml vs(326.7±84.1)ml,P=0.002],intraoperative fluorosco-py frequency[(2.4±0.6)times vs(3.4±0.7)times,P＜0.001],and postoperative walking time[(40.2±6.8)days vs(50.5±10.1)days,P＜0.001].The average follow-up time was of(15.4±1.3)months,and the DPA cohort resumed full weight-bearing activity significantly earlier than that in the K-L counterpart[(79.4±6.9)days vs(86.2±7.1)days,P=0.003].The VAS scores significantly decreased(P＜0.05),while Harris score,Merle D'Aobign é-Postel score,hip flexion-extension ROM,and internal-external rotation ROM significantly increased in both groups over time(P＜0.05).The DPA group was significantly superior to the K-L group regarding VAS[(4.1±1.0)vs(5.4±1.2),P＜0.001;(1.7±1.0)vs(3.0±0.8),P＜0.001],Harris score[(74.2±5.0)vs(71.1±3.6),P=0.026;(87.0±3.1)vs(83.3±3.8),P=0.002],hip flexion-extension ROM[(75.5±8.5)° vs(69.5±7.0)°,P=0.014;(92.4±11.8)° vs(86.0±9.2)°,P=0.045]at 1 and 6 months postoperatively,and Merle D'Aobign é-Postel score[(13.0±1.3)vs(11.7±1.4),P=0.003]1 month after surgery.As for imaging,there was no statistically significant difference in the quality of fracture reduction,fracture healing time,Tonnis hip degeneration grade,ectopic ossification,and femoral head necrosis be-tween the two groups(P＞0.05).[Conclusion]The DPA approach has advantages of fewer bleeding,shorter incisions,and fewer complica-tions for ORIF of acetabular fractures involving the posterior wall,and achieves more satisfactory short-term outcomes over the traditional K-L approach.
acetabular fractures involving posterior walldirect posterior approachKocher and Langenbeck approachopen reduction and internal fixation
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