Reconstruction of posterior acetabular wall bone defect using a fibular autograft: A case report
DOI:
https://doi.org/10.58814/01208845.583Keywords:
Hip Dislocation, Fibula, Bone Transplantation, Acetabulum, Joint Instability, Case ReportsAbstract
Introduction: The use of various bone grafts for acetabular defects has been described in the literature. This case report describes the use of a fibular graft to manage secondary hip instability following a posterior hip dislocation associated with a posterior wall acetabular fracture.
Case presentation: A patient sustained a traumatic hip dislocation in 2020, underwent initial management with closed reduction, followed by open reduction and capsular repair with placement of a titanium bone-anchoring system. Residual hip instability persisted, and three years after the initial trauma, the patient sustained a new dislocation due to low-energy trauma. The patient was admitted to a tertiary care center, where a posterior wall acetabular fracture with resorption of the bone fragments and a post-traumatic bone defect was documented, the latter was reconstructed through the novel use of a non-vascularized structural fibular diaphyseal autograft. At the 12-month follow-up, good outcomes were observed.
Conclusion: It is important to maintain a high index of suspicion to rule out acetabular fractures associated with hip dislocations. It is fundamental to restore the bony structural support of the acetabulum to prevent or treat hip instability. The use of fibular bone autograft represents an appropriate option to provide stability to the hip and posterior wall acetabular fractures.
Downloads
References
1. Cooper J, Tilan J, Rounds AD, Rosario S, Inaba K, Marecek GS. Hip dislocations and concurrent injuries in motor vehicle collisions. Injury. 2018;49(7):1297–301. http://doi.org/10.1016/j.injury.2018.04.023 PMID: 29739656.
2. Jawad Z, Abdul W, Topping J, Dunn J, Lewis J, Mohanty K. Traumatic Native Hip Dislocations: An Audit at a Major Trauma Centre and Assessment of Clinical Practice at Centres Across the United KingdomCureus. 2024;16(4):e58314. https://doi.org/10.7759/cureus.58314 PMID: 38752056; PMCID: PMC11095414.
3. Zheng X, Chen C, Zhao Y, Jiang J, Wang Y. A comprehensive study of hip dislocation: global health burden from 1990 to 2021 and its predictions to 2030. Front Public Health. 2025;13:1594523. https://doi.org/10.3389/fpubh.2025.1594523 PMID: 40994749; PMCID: PMC12454331.
4. Ponkilainen V, Kuitunen I, Liukkonen R, Vaajala M, Reito A, Uimonen M. The incidence of musculoskeletal injuries: a systematic review and meta-analysis. Bone Joint Res. 2022;11(11):814–25. https://doi.org/10.1302/2046-3758.1111.BJR-2022-0181.R1 PMID: 36374291; PMCID: PMC9680199.
5. Milenkovic S, Mitkovic M, Mitkovic M. Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture. Eur J Trauma Emerg Surg. 2022;48(1):613–19. https://doi.org/10.1007/s00068-020-01495-x PMID: 32929549.
6. Pandiaraj P, Perumal R, Soundararajan M, Imran A, Jayaramaraju D. Spectrum, management strategies, and outcomes of isolated posterior wall acetabular fractures: A retrospective study of 129 patients. J Clin Orthop Trauma. 2026;74:103363. https://doi.org/10.1016/j.jcot.2026.103363 PMID: 41705064; PMCID: PMC12907898.
7. Kellam P, Ostrum RF. Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma. 2016;30(1):10–6. https://doi.org/10.1097/BOT.0000000000000419 PMID: 26849386.
8. Beebe MJ, Bauer JM, Mir HR. Treatment of hip dislocations and associated injuries: Current state of care. Orthop Clin North Am. 2016;47(3):527–49. https://doi.org/10.1016/j.ocl.2016.02.002 PMID: 27241377.
9. Sun B, Li K, Zhu Y, Long H. Posterior wall reconstruction using intertrochanteric crest strut graft in comminuted posterior acetabular wall fractures. Hip Int. 2013;23(2):199–203. https://doi.org/10.5301/hipint.5000011 PMID: 23543469.
10. Pascarella R, Commessatti M, Politano R, Maresca A, Del Torto M, Chehrassan M, et al. Bone graft from greater trochanter in posterior wall fractures with impacted fragments. J Orthop Traumatol. 2014;15(3):181–7. https://doi.org/10.1007/s10195-014-0291-1 PMID: 24671489; PMCID: PMC4182615.
11. Zha G-C, Sun J-Y, Chen L, Zheng H-M, Wang Q, Jin Y. Late reconstruction of posterior acetabular wall fractures using iliac crest. J Trauma Acute Care Surg. 2012;72(5):1386–92. https://doi.org/10.1097/TA.0b013e318248bdef PMID: 22673271.
12. Gupta S, Mittal N, Virk JS. Use of tricortical iliac crest strut autograft in comminuted posterior wall acetabular fractures: A case series. Chin J Traumatol. 2018;21(1):58–62. https://doi.org/10.1016/j.cjtee.2017.08.005 PMID: 29212625; PMCID: PMC6114123.
13. Sharma V, Bansal H, Mittal S, Farooque K, Nayak T. Tricortical iliac crest graft as a salvageable option in the reconstruction of comminuted posterior wall acetabular fractures: our experience from a level 1 trauma centre. Arch Orthop Trauma Surg. 2023;143(1):277–85. https://doi.org/10.1007/s00402-021-04064-y PMID: 34258659.
14. Thompson VP, Epstein HC. Traumatic dislocation of the hip: A survey of two hundred and four cases covering a period of twenty one years. J Bone Joint Surg Am. 1951;33-A(3):746–78. PMID: 14850515.
15. Menger MM, Braun BJ, Herath SC, Küper MA, Rollmann MF, Histing T. Fractures of the femoral head: a narrative review. EFORT Open Rev. 2021;6(11):1122–31. https://doi.org/10.1302/2058-5241.6.210034 PMID: 34909230; PMCID: PMC 8631236.
16. Tsutsumi M, Nimura A, Akita K. Clinical anatomy of the musculoskeletal system in the hip region. Anat Sci Int. 2022;97(2):157–64. https://doi.org/10.1007/s12565-021-00638-3 PMID: 34686966; PMCID: PMC8817995.
17. Safran MR, Murray IR, Andrade AJ, Aoki SK, Ayeni OR, Balakumar J, et al. Criteria for the operating room confirmation of the diagnosis of hip instability: The results of an international expert consensus conference. Arthroscopy. 2022;38(10):2837-49.e2. https://doi.org/10.1016/j.arthro.2022.03.027 PMID: 35378192.
18. Kuniyoshi S, Nakasone S, Takaesu M, Igei T, Washizaki F, Nishida K. Total hip arthroplasty in patients under 30 years who have osteonecrosis of the femoral head: Mean follow-up of more than 120 months. J Arthroplasty. 2025;40(10S1):S79–S85. https://doi.org/10.1016/j.arth.2025.05.106 PMID: 40473057.
19. Buddhiraju A, Khanuja HS, Hegde V, Sequeira SB, Mont MA, Jones LC. Epidemiology, management, and systematic review of surgical trends for patients who have osteonecrosis of the femoral head. J Arthroplasty. 2025;40(10S1):S112-S119.e1. https://doi.org/10.1016/j.arth.2025.06.002 PMID: 40490143.
20. Azi ML, Aprato A, Santi I, Kfuri M Jr, Masse A, Joeris A. Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2016;17(1):465. https://doi.org/10.1186/s12891-016-1312-4 PMID: 27829447; PMCID: PMC5103502.
21. Wang W, Yeung KWK. Bone grafts and biomaterials substitutes for bone defect repair: A review. Bioact Mater. 2017;2(4):224–7. https://doi.org/10.1016/j.bioactmat.2017.05.007 PMID: 29744432; PMCID: PMC5935655.
22. Kwong-Ting H, Kam-Yiu W. Use of structural bone graft for reconstruction of acetabular defects in primary total hip arthroplasty: A 13-year experience. J Orthop Trauma Rehabil. 2016;20(1):30–4. https://doi.org/10.1016/j.jotr.2015.06.002
23. Oommen AT, Krishnamoorthy VP, Poonnoose PM, Korula RJ. Fate of bone grafting for acetabular defects in total hip replacement. Indian J Orthop. 2015;49(2):181–6. https://doi.org/10.4103/0019-5413.152462 PMID: 26015607; PMCID: PMC4436484.
24. Liu S, Tao S, Tan J, Hu X, Liu H, Li Z. Long-term follow-up of fibular graft for the reconstruction of bone defects. Medicine (Baltimore). 2018;97(40):e12605. https://doi.org/10.1097/MD.0000000000012605 PMID: 30290632; PMCID: PMC6200552.
25. Reátiga J, Arzuza L, Guzmán J, Molina J, Ríos X. Fibular strut graft placement for an open distal femur fracture with a critical bone defect: A case report. Trauma Case Rep. 2022;42:100712. https:/doi.org/10.1016/j.tcr.2022.100712 PMID: 36210920; PMCID: PMC9535308.
26. Jie K, Feng W, Li F, Wu K, Chen J, Zhou G, et al. Long-term survival and clinical outcomes of non-vascularized autologous and allogeneic fibular grafts are comparable for treating osteonecrosis of the femoral head. J Orthop Surg Res. 2021;16(1):109. https://doi.org/10.1186/s13018-021-02246-3 PMID: 33541413; PMCID: PMC7863426.
27. Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Mineo GV. Incidence of donor site morbidity following harvesting from iliac crest or RIA graft. Injury. 2014;45 Suppl 6:S116-20. https://doi.org/10.1016/j.injury.2014.10.034 PMID: 25457330.
28. Ge C-Y, Dong L, Xu Z-W, Yang W-L, Qian L-X, Yang X-W, et al. Avulsion fracture of the anterior superior iliac crest following autograft for anterior lumbar fusion: case report and literature review. Front Surg. 2024;11:1327028. https://doi.org/10.3389/fsurg.2024.1327028 PMID: 38327545; PMCID: PMC10847530.
29. van de Wall BJM, Beeres FJP, Rompen IF, Link BC, Babst R, Schoeneberg C, et al. RIA versus iliac crest bone graft harvesting: A meta-analysis and systematic review. Injury. 2022;53(2):286–293. http://doi.org/10.1016/j.injury.2021.10.002 PMID: 34756411.
30. Migliorini F, Cuozzo F, Torsiello E, Spiezia F, Oliva F, Maffulli N. Autologous bone grafting in trauma and orthopaedic surgery: An evidence-based narrative review. J Clin Med. 2021;10(19):4347. https://doi.org/10.3390/jcm10194347 PMID: 34640364; PMCID: PMC8509778.
31. Katz MS, Ooms M, Heitzer M, Peters F, Winnand P, Kniha K, et al. Postoperative morbidity and complications in elderly patients after harvesting of iliac crest bone grafts. Medicina (Kaunas). 2021;57(8):759. https://doi.org/10.3390/medicina57080759 PMID: 34440965; PMCID: PMC8401410.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The Author(s).
This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
