Midfoot “H-Plate” for operative fixation of posterior wall acetabular fractures: a technical trick and case series

Abstract

Background: Acetabular fractures involving the posterior wall remain challenging to treat, with no gold standard fixation method established. We describe a novel technique using Synthes 2.7 mm non-locking plates originally designed for the midfoot. Methods: Retrospective review of 120 patients with posterior wall acetabular fractures treated with H-plates at a Level-1 trauma center (2012-2021). Patient demographics, operative parameters, and outcomes were analyzed. Results: The cohort was predominantly male (67.5%) with motor vehicle collisions as the primary mechanism (89.1%). Forty-seven patients (39.1%) received isolated H-plate fixation. Operative time was significantly shorter with isolated H-plates versus additional hardware (2.25 ± 0.60 vs 2.70 ± 0.91 h; p = 0.003). No patients required reoperation for fixation failure. Total hip arthroplasty was required in 9.2% of patients. Conclusion: The H-plate offers a simplified approach to posterior wall fixation with promising preliminary results, though longer follow-up is needed.