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Posterior wall acetabular fractures involving a large portion the wall's width and with extensive comminution are difficult fractures to manage operatively. Cortical substitution with a pelvic reconstruction plate and supplemental spring plates has been the traditional means of fixation for these fractures. This option, however, requires the use of multiple, unlinked plates and provides no reliable option for peripheral fixation in comminuted fragments. We describe a novel technique for operative fixation of large, comminuted posterior wall fractures using a single distal tibia pilon plate with the option for peripheral locking screw fixation and report on a series of 20 consecutive patients treated with this method.

The authors describe the technique of blocking K-wires to facilitate the freehand percutaneous plating of periarticular tibia fractures. The blocking K-wires facilitate anatomic accuracy of plate placement, a limiting feature of percutaneous plating technique particularly in the absence of a plate-specific jig. The described technique is to be applied as part of a staged surgical protocol utilizing temporary external fixation and directed at the preservation of the periarticular soft-tissues of the tibia.

Summary: A 93-year-old patient with an unstable fracture-dislocation of the glenohumeral joint and medical problems that precluded open surgery was first managed by an unsuccessful closed reduction. Temporary transarticular pin fixation then was used successfully, allowing the patient to return to early activities with minimal morbidity.