Background: The hip joint often is unstable after a posterior wall fracture, and surgical management often is indicated to restore hip stability and congruency. The conventional surgical technique for the management of posterior wall acetabular fractures involves the use of lag screws and buttress plates for internal fixation. The use of spring plates and buttress plates has been described and is associated with considerably improved fixation strength. This video demonstrates the use of a spring plate in combination with lag screw and buttress plate fixation for the management of a comminuted posterior wall fracture. The video also discusses the midterm results of a case series of patients who underwent surgical treatment via the technique.

Surgical Technique: The patient is placed in the prone position, and the Kocher-Langenbeck approach is used. The sciatic nerve is identified and protected. Fracture reduction is performed and stabilized provisionally. Definitive fixation involves the use of a three-holed convex spring plate to stabilize the fracture, followed by insertion of a lag screw and buttressing with the use of a 3.5-mm pelvic reconstruction plate. Intraoperative Judet radiographs are obtained to evaluate fracture reduction and screw positioning.

Goals: The goal of this video is to demonstrate the exact surgical technique for open reduction and internal fixation of a comminuted posterior wall acetabular fracture with the use of a spring plate in a stepwise manner. After viewing this video, surgeons should be able to appreciate and fully understand the steps involved in the fixation of a posterior acetabular wall fracture via this technique.