Consequences of Transverse Acetabular Fracture Malreduction on Load Transmission Across the Hip Joint

Objective: To evaluate the biomechanical behavior of gap and step malreductions in a model of transverse acetabular fracture. Design: Cadaver pelvis loading in simulated single-leg stance with intact acetabulum, after transverse acetabular fracture anatomically reduced, and after step and gap malreduction. Five transtectal transverse fractures; five juxtatectal transverse fractures. Setting: Quasi-static loading of the hip with simulated abductor mechanism to physiologic loads with pressure-sensitive film interposed in the joint to determine contact area and contact pressure within the hip joint. Main Outcome Measurement: Hip joint contact parameters: contact area, peak and mean contact pressure, and load distribution. Results: Step malreduction of the transtectal transverse fracture resulted in significantly increased peak contact pressures (20.5 megapascals) in the superior acetabular articular surface as opposed to the intact acetabulum (9.1 megapascals). Gap malreduction of transtectal transverse fracture and step and gap malreduction of juxtatectal fracture did not result in significantly increased contact pressures in the hip. Conclusion: Step malreduction of a transverse acetabular fracture in the superior articular surface results in abnormally high contact forces and may predispose to the development of post-traumatic arthritis.