Clinical and Radiological Outcomes of Spring Plate Augmentation in Posterior Wall Acetabular Fractures: A Prospective Cohort Study

BACKGROUND: Posterior wall acetabular fractures with comminution present fixation challenges, as conventional buttress plating may be insufficient to maintain articular congruity. Spring plate augmentation has been proposed to improve fragment-specific stability, but prospective clinical evidence remains limited. MATERIALS AND METHODS: This prospective cohort study evaluated clinical, radiological, and functional outcomes of spring plate-assisted fixation in posterior wall acetabular fractures in 60 patients treated between 2017 and 2023, with a minimum follow-up of 2 years. All fractures were managed via the Kocher-Langenbeck approach using spring plate augmentation combined with a reconstruction plate in buttress configuration. Functional outcomes were assessed using the modified Merle d'Aubigné and Postel (mMDP) score, whereas radiological outcomes were evaluated using Matta's reduction criteria and radiological grading. RESULTS: Anatomical reduction was achieved in 81.7% of the patients. At the final follow-up, 91.7% demonstrated satisfactory (excellent or good) radiological outcomes. Functional outcomes improved significantly over time, with a mean mMDP score of 16.4 at 2 years (P < 0.001), and 86.7% of patients achieved satisfactory functional results. Anatomical reduction was strongly associated with superior functional outcomes (P = 0.011). Posttraumatic arthritis occurred in 8.3% of patients, and 3.3% required conversion to total hip arthroplasty. CONCLUSION: Spring plate augmentation combined with buttress plating provides reliable fixation for posterior wall acetabular fractures, favorable hip function, and low mid-term arthroplasty conversion rates.