MODERN APPROACHES AND BIOMECHANICAL FOUNDATIONS IN THE SURGICAL TREATMENT OF POSTERIOR COLUMN PELVIC FRACTURES

Abstract

Posterior column fractures of the pelvis and acetabulum remain among the most technically demanding injuries in orthopaedic trauma surgery, occurring in high-energy trauma among younger patients and in low-energy falls among the elderly. Optimal management requires anatomical reduction and stable internal fixation to restore the load-bearing architecture of the hip joint and to minimize the risk of post-traumatic arthritis, nonunion, and functional impairment. This article presents an integrative review of contemporary surgical strategies and their underlying biomechanical rationale for posterior column pelvic fractures, synthesizing clinical, cadaveric, and composite-bone-model evidence published over the past three decades. The review traces the evolution of fixation philosophy from foundational classification systems and open surgical approaches to current minimally invasive percutaneous techniques, reconstruction plating, and novel implant geometries such as angular and dynamic plates. Comparative biomechanical data drawn from cadaveric and composite bone models are analyzed, including construct stiffness, cyclic-load failure thresholds, and interfragmentary displacement across single-plate, dual-plate, screw-only, and hybrid plate–screw configurations. Particular attention is given to antegrade and retrograde screw fixation via posterior and anterior corridors, and to the comparative performance of standard cannulated screws versus cannulated compression headless screws. The materials and methods section presents a structured comparative synthesis, supported by tables and diagrams, of fixation stiffness values, complication profiles, and clinical outcome indicators reported in the American and Kazakhstani orthopaedic literature. Findings indicate that dual-plate and angular-plate constructs, as well as compression headless screw systems, provide superior mechanical stability relative to single-implant fixation, though clinical decision-making must also weigh soft-tissue morbidity, surgical exposure, and patient-specific bone quality. The review concludes that an evidence-based, biomechanically informed selection of fixation strategy, tailored to fracture pattern and patient factors, is essential for optimizing surgical outcomes and long-term hip joint preservation