Postoperative radiograph after spring plate fixation of a posterior wall acetabular fracture

The patient presented to the emergency department with an acute traumatic hip dislocation. Urgent reduction was performed, followed by CT imaging to define the associated acetabular injury.

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Case typeTraumatic hip dislocation with posterior wall acetabular fracture
Emergency managementUrgent hip reduction
Key imagingPost-reduction CT to define fragment size and fracture morphology
Fixation challengeVery small posterior wall fragment unsuitable for direct screw fixation alone
ProcedureOpen reduction and internal fixation using a spring plate with buttress support
Fixation objectiveSupport the small fragment and restore posterior acetabular stability

Initial Assessment and Emergency Management

The initial radiograph demonstrated hip dislocation. After urgent reduction in the emergency department, CT was obtained to assess associated acetabular injury that might not be fully characterized on plain radiographs. A different example of complex hip trauma can be seen in the left femoral neck fracture case treated with cementless total hip arthroplasty.

Initial radiograph showing acute traumatic hip dislocation before reduction
Figure 1. Initial radiograph showing acute traumatic hip dislocation before emergency reduction.

CT Diagnosis

Post-reduction CT demonstrated a posterior wall acetabular fracture with a very small posterior wall fragment. The fragment size made conventional direct screw fixation alone less suitable because there was limited bone available for secure screw purchase.

Axial CT image after reduction showing a small posterior wall acetabular fracture fragment
Figure 2. Axial CT image after reduction demonstrating the posterior wall acetabular fracture and a small fragment.
Additional axial CT image confirming the small posterior wall acetabular fragment
Figure 3. Additional axial CT image confirming the small posterior wall fragment after hip reduction.

Why Use a Spring Plate?

The objective was to support the very small posterior wall fragment without relying on a direct screw through limited bone. The spring plate acts as a fragment-supporting device and is reinforced by a buttress plate as part of the fixation construct.

Surgical Treatment

Open reduction and internal fixation of the posterior wall acetabular fracture was performed. Because the fragment was very small, a spring plate was used to support it, with a buttress plate reinforcing the construct.

  • Reduction of the posterior wall fragment and restoration of posterior acetabular support.
  • Use of a spring plate to capture and support the small osseous fragment.
  • Reinforcement of the fixation with a buttress plate.
  • Intraoperative imaging to assess implant position and the relationship of the fixation construct to the hip joint.

What Is the Spring Plate Technique?

The spring plate technique is useful in selected posterior wall acetabular fractures when the fragment is small or thin and cannot be safely secured with a conventional lag screw alone. The spring plate provides elastic fragment support, while the buttress plate adds stability to the overall construct.

Authoritative medical references:

Postoperative Imaging

Postoperative images demonstrate the reduced hip and the fixation construct from multiple projections. These views assess plate position, spring plate support, and the relationship of the implants to the joint.

Postoperative radiograph showing a buttress plate with spring plate support
Figure 4. Postoperative radiograph showing the reduced hip and fixation construct using a buttress plate with spring plate support.
Postoperative view showing the posterior wall acetabular fixation construct
Figure 5. Postoperative projection demonstrating the position of the posterior wall fixation construct.
Postoperative radiograph showing the plate and spring plate construct
Figure 6. Postoperative radiograph from another projection showing the plate-and-spring-plate construct.
Additional postoperative radiograph showing maintained hip reduction
Figure 7. Additional postoperative radiograph demonstrating the fixation construct and maintained hip reduction.
Oblique postoperative view of the acetabular fixation construct
Figure 8. Oblique postoperative view of the acetabular fixation construct.
Postoperative AP view demonstrating acetabular plate and spring plate support
Figure 9. Postoperative AP view demonstrating the acetabular plate and spring plate support.
Intraoperative fluoroscopic view confirming the fixation construct position
Figure 10. Intraoperative fluoroscopic view confirming the position of the fixation construct.
Additional oblique postoperative view showing posterior wall fixation
Figure 11. Additional oblique postoperative view showing the posterior wall fixation construct.

Clinical Lesson

In a hip dislocation associated with a posterior wall acetabular fracture, management does not end with reduction of the dislocation. Post-reduction CT helps define fracture morphology, fragment size, and fixation strategy. Very small posterior wall fragments may require a specialized solution such as spring plate fixation rather than conventional screws alone.

Continue through the trauma topic cluster: browse the orthopedic case library, review the fracture and trauma surgery service, or explore the orthopedic services available for complex cases.
Medical note: This case is presented for education. Treatment decisions depend on fracture morphology, hip stability, fragment size, physical examination, and imaging findings in each individual patient.

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