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Objective:To investigate the efficacy and safety of the "frame and buttress" fixation in the treatment of acetabular quadrilateral fractures.Methods:A total of 26 patients with acetabular quadrilateral fractures treated with the "Frame and buttress" fixation strategy (reconstructing frame and providing buttress for quadrilateral surface) from January 2017 to January 2021 were retrospectively analyzed in the Department of Orthopaedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, including 17 males and 9 females, aged 47.7±16.5 years, (range, 25-71 years). There were 13 cases from car accidents, 8 cases from falls, and 5 cases from heavy objects. Quadrilateral fractures were classified according to whether the anterior column (A) and posterior column (P) of the acetabulum were fractured and whether the quadrilateral plate (Q) was partially (1) or completely (2) separated from the two columns. Among these cases, there were 5 cases of type AQ1, 1 case of type AQ2, 1 case of type PQ2, 14 cases of type APQ1 and 5 cases of type APQ2. The "frame and buttress" fixation strategy was used to perform open reduction and internal fixation. The Matta scale was used to assess the quality of resurfacing based on pelvic radiographs, and the Matta modified Merle d'Aubigne and Postel scores were referenced to evaluate hip function.Results:All the 26 patients successfully completed the operation, the operation time was 88.1±57.8 min (range, 90-320 min), the intraoperative bleeding was 753.8±309.5 ml (range, 400-1 400 ml). There were 14 cases of anatomical reduction, 8 cases of satisfactory reduction and 4 cases of unsatisfactory reduction with an excellent rate of 85% (22/26), the excellence rate was 85% (22/26). All patients were followed up for 16.3±4.3 months (range, 12-24 months). The hip function score after operation was higher than that before operation, and the difference was statistically significant ( F=19.80, P<0.001). The hip function score was 13.1±2.2 at 3 months postoperatively, increased to 15.9±2.3 at 6 months postoperatively, and increased to 16.6±1.9 at the last follow-up, with a statistically significant difference ( P<0.001). After operation, 5 patients showed symptoms of lateral femoral cutaneous nerve injury such as hypoesthesia and numbness in the anterolateral thigh. During the follow-up, there was no ectopic ossification, traumatic arthritis, necrosis of the femoral head and central dislocation of the femoral head. Conclusion:The "frame and buttress" fixation strategy based on quadrilateral fracture typing for acetabular quadrilateral fracture open reduction internal fixation provides strong fixation, satisfactory reduction quality, and facilitates joint function recovery after operation.
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Objective:To explore the safety and efficacy of the minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire and 3D-printed external template technique.Methods:A retrospective study was conducted of the clinical data of 21 patients with unstable pelvic fracture who had undergone minimally invasive treatment at Department of Orthopaedics, Union Hospital from May 2016 to July 2018 using 3D-printed external templates and the blunt head technique of Kirschner wire. There were 7 males and 14 females with an age of 43.6 years (from 19 to 65 years). According to the Tile classification, there were 3 cases of B1, 7 ones of B2, 6 ones of C1 and 5 ones of C2. The intraoperative fluoroscopy, operation time, postoperative fracture reduction and functional recovery of the pelvis at the last follow-up were recorded.Results:The 21 patients were followed up for an average of 16.3 months (from 12 to 24 months). A total of 33 wires were inserted in the 21 patients, including 15 S 1 ones and 18 S 2 ones. The intraoperative fluoroscopy ranged from 13 to 27 times, averaging 21.8 times. The operation time ranged from 65 to 130 min, averaging 88.6 min. The anterior subcutaneous internal fixation was used to fix the anterior ring in 9 patients. No vascular injury occurred during the operation. By the Matta criteria, the postoperative fracture reduction was assessed as excellent in 14 cases, good in 5, and fair in 2, giving an excellent to good rate of 90.5% (19/21). By the Majeed scoring system, the pelvic function at the last follow-up was assessed as excellent in 10 cases, good in 8, and fair in 3, giving an excellent to good rate of 85.7% (18/21). Lateral femoral cutaneous nerve injury occurred in 2 patients but was recovered by the 3-month follow-up. No other complications were follwed up. Conclusion:The minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire assissted by 3D-printed external templates is safe and effective, showing advatages of reduced fluoroscopic frequency and operation time.
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Objective:To explore the feasibility, safety and clinical efficacy of using the self-developed acetabular posterior wall and column integrative anatomical plate to treat various types of posterior wall/column fractures.Methods:Between January 2016 and January 2019, 21 patients involving acetabular posterior wall and/or column were treated with the novel acetabular posterior wall and column integrative plate, the data were collected and retrospectively analyzed. There were 11 males and 10 females, with an average of 48 years old (range, 18-65 years old). According to the classification of AO/OTA, there were 6 simple fractures, 9 comminuted fractures, and 6 associated with joint surface compression of posterior wall; and there were 16 simple acetabular posterior wall fractures and 5 cases associated with acetabular posterior column fractures. Before operation, the CT data of each patient was collected and imported into Mimics software to reconstruct and print a 3D model of pelvis and injured and mirrored side to simulate operation. All patients were treated with a single Kocher-Langenbeck approach for posterior acetabular fractures, and fixed with the novel integrated anatomical plate after satisfactory reduction was achieved. Matta score was used to evaluate the quality of fracture reduction, and the modified Merle D'Aubigné-Postel score was adopted to evaluate functional recovery of hip joint.Results:21 patients involved in this study, the average time of plate insertion after successful reduction was 20 min (range, 15-30 min); the mean time of operation was 180 min (range, 90-300 min); the intraoperative mean bleeding volume was 700 ml (range, 300-1 500 ml). All the incisions healed by level 1 classification, and no incisions infection and sciatic nerve injury occurred. The patients included in the study have been followed up for at least one year and the imaging data was intact, the mean follow-up time was 19 month (range, 12-26 month). The fracture reduction was evaluated according to the Matta score: 16 cases were anatomical reduction, 3 cases were satisfactory reduction, 2 cases were unsatisfactory reduction, the satisfactory rate of reduction was 90.5% (19/21); the modified Merle D'Aubigné-Postel score at 3 month was 13.0±2.2 (range, 9-16), 6 month was 15.8±2.4 (range, 10-18) and last follow up was 17.0±1.8 (range, 13-18), respectively; the difference was statistically significant ( F=15.38, P < 0.001). At the last follow-up, 15 cases were excellent, 3 cases were good and 3 cases were fair, the total excellent and good rate was 85.7% (18/21). One case developed symptoms of sciatic nerve injury after operation, but the symptoms resolved after treating with neurotrophic drug by 6 months. 2 cases developed arthritis related pain after operation, receiving symptomatic treatment with oral painkillers. During the follow-up period, no complications such as plate broken and screw loosen occurred. Conclusion:The use of an integrative anatomical plate for treating posterior wall/column fractures of acetabulum achieved satisfactory fixation and postoperative functional recovery.
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Objective:To investigate the advantages and disadvantages and clinical effects of integrated acetabular quadrilateral surface buttress plate in the treatment of acetabular both column fractures.Methods:From September 2017 to March 2019, 14 patients with acetabular both column fractures were treated with integrated quadrilateral acetabular buttress plate and were followed up. The clinical data were retrospectively analyzed. There were 10 males and 4 females with an average age of 53.2 years (range, 26-75 years). Fracture classification were both column fractures according to the Letournel-Judet classification system, including 11 cases of combined posterior wall without posterior dislocation. The time from injury to operation was 8-19 days, with an average of 10.3 days. All operations were performed with a supra-ilioinguinal approach. After satisfactory reduction, the integrated acetabular quadrilateral surface buttress plate was used to fix the anterior and posterior column and quadrilateral fractures at the same time. After operation, Matta criteria was used to evaluate the quality of fracture reduction on postoperative images, and modified Merle d'Aubigné-Postel score to evaluate hip joint function.Results:The average operation time was 180 min (range, 120-320 min), and the intraoperative average blood loss was 980 ml (range, 700-1 600 ml). Operations were performed successfully with none intraoperative reshaping conducted, and the plate could fit into the bone surface well. All 14 patients were followed up with an average of 15.6 months (range, 9-20 months). During the follow-up, all fractures healed with an average of 3 months (range, 2.5-5 months). The reduction quality evaluated by the Matta criteria were 7 anatomical, 5 satisfactory, and 2 unsatisfactory, with an excellent and good rate of 85.7% (12/14). The hip joint function at the last follow-up was in accordance with the modified Merle d'Aubigné-Postel score was 12-18 points, with an average of 16.9 points, of which 8 excellent, 4 good, and 2 fair. The excellent and good function rate was 85.7% (12/14). During the operation, 1 patient had a rupture of about 1 cm of the peritoneum during the separation of the spermatic cord, which was immediately sutured and repaired. One patient had obturator nerve paralysis after the operation, without special treatment, and the paralysis symptoms were relieved during the 6th-month follow-up. There were no other operation-related complications.Conclusion:For both-column fractures characterized by central dislocation of the femoral head, the integrated acetabular quadrilateral buttress plate can simultaneously fix the anterior and posterior columns and quadrilateral surface at the same time. Satisfactory reduction and functional outcomes could be achieved by the novel plates.
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Objective:To introduce a novel anatomical supra-pectineal quadrilateral surface buttress plate, and explore its advantages, disadvantages and clinical efficacy in the treatment of complex acetabular fractures.Methods:Data of eighteen cases of acetabular fractures treated in our department from March 2017 to March 2019were retrospectively analyzed. There were 15 males and 3 females with an average age of 49.6 years (range, 27-62 years). According to the Letournel-Judet’s classification, there were 3 cases of anterior column fractures (involving quadrilateral surface), 2 cases of "T" shaped, 8 of cases anterior column and posterior hemi-transverse (ACPHT) and 5 cases of double columns fractures. The time from injury to operation was 5-14 days (mean, 7 days). Before operation, all patients were taken pelvic anterior-posterior X-ray and CT scan. All patients were adopted supra-ilioinguinal approach and fixed by supra-pectineal quadrilateral surface buttress plate. Surgical time, intraoperative blood loss and postoperative complications were collected. After operations all patients were taken pelvic X-ray in anterior-posterior and Judet position, as well as CT scan. The radiographic quality of reduction was evaluated by Matta criteria and hip functions were evaluated by Matta Modified Merle d’Aubigné-Postel scoring system.Results:The average surgical time was 130 min (range, 100-200 min). The average blood loss was 560 ml (range, 400-900 ml). An additional shaping was unnecessary in 18 patients who were implanted with the anatomical supra-pectineal quadrilateral surface buttress plate and all patients were operated successfully. All patients were followed up for an average time of 9 months (range, 6-15 months). The quality of fracture reduction was evaluated according to Matta standard, of which there were 11 cases excellent, 4 cases good, and 3 cases poor, with an excellent rate of 83.3% (15/18). At the latest follow-up, the function of the hip joint was evaluated according to the Matta Modified Merle d’Aubigné-Postel scoring system for a mean of 15.8 scores (range, 12-18 scores), of which there were 10 cases excellent, 6 cases good, 2 cases fair, with an excellent rate of 88.9% (16/18). All patients recovered well, and there were 2 cases of lateral femoral cutaneous nerve injury postoperative who had recovered one month later. There was no other postoperative complications.Conclusion:The anterior and posterior column and quadrilateral surface could be stabilized simultaneously by the anatomical supra-pectineal quadrilateral surface buttress plate without intraoperative shaping. Moreover, it is more likely to obtain a satisfactory clinical outcome by using this special plate with lower complications and rigid fixation. Therefore, it is a kind of internal fixation method worthy of promotion in the treatment of complex acetabular fractures.
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Objective@#To explore the clinical efficacy of combined plates through superior-ilioinguinal approach for acetabular fractures involving anterior wall and anterior column.@*Methods@#Data of twelve patients with acetabular fractures involving anterior column and anterior wall who were treated by combined plates from June 2015 to August 2017 were retrospectively analyzed. Among them 9 cases were males and 3 cases were females, with an average age of 55.4 years old (range, 22-69 years old). Three cases were combined with posterior hemitransverse fractures. Six cases were combined with posterior column fractures. The mean time from injury to operation was 7.2 d (range, 5-12 d). Simultaneous management of anterior wall and anterior column fractures were achieved through single superior-ilioinguinal approach using the novel combined plates in all patients. The image results were evaluated by Matta’s standard and the functional outcome was evaluated by the Matta's improved Merle d'Aubigné-Postel scores system at the final follow-up.@*Results@#All 12 patients were followed up for average 18.3 months (range, 12-24 months). Average blood loss was 560 ml (range, 200-1 200 ml) and average operative time was 102 min (range, 88-190 min). The mean time of bony union was 2.9 months (range, 2.5-4.5 months). The quality of postoperative fracture reduction was evaluated according to Matta’s standard, of which there were 7 cases anatomic, 3 cases satisfactory, and 2 cases unsatisfactory, with an anatomic or satisfactory rate of 83.3%(10/12). The average Matta’s improved Merle d’Aubigne-Postel score was 16.1 (range, 12-18), and there were 8 cases excellent, 2 cases good, 1 case fair and 1 case poor, with an excellent or good rate of 83.3%(10/12). Rupture of the peritoneum occurred in one patient during the surgery which was repaired immediately. One patient suffered obturator nerve palsy and was fully recovered in one year. No inguinal hernia, surgical site infection and femoral head avascular necrosis occurred.@*Conclusion@#The combined plates could provide simultaneous fixation for anterior column and anterior wall fractures firmly through single superior-ilioinguinal approach. Satisfactory reduction and functional outcomes could be achieved by the novel plates.
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Objective To explore the clinical efficacy of combined plates through superior?ilioinguinal approach for ace?tabular fractures involving anterior wall and anterior column. Methods Data of twelve patients with acetabular fractures involv?ing anterior column and anterior wall who were treated by combined plates from June 2015 to August 2017 were retrospectively an?alyzed. Among them 9 cases were males and 3 cases were females, with an average age of 55.4 years old (range, 22-69 years old). Three cases were combined with posterior hemitransverse fractures. Six cases were combined with posterior column fractures. The mean time from injury to operation was 7.2 d (range, 5-12 d). Simultaneous management of anterior wall and anterior column frac?tures were achieved through single superior?ilioinguinal approach using the novel combined plates in all patients. The image re?sults were evaluated by Matta’s standard and the functional outcome was evaluated by the Matta's improved Merle d'Aubigné?Pos?tel scores system at the final follow?up. Results All 12 patients were followed up for average 18.3 months (range, 12-24 months). Average blood loss was 560 ml (range, 200-1 200 ml) and average operative time was 102 min (range, 88-190 min). The mean time of bony union was 2.9 months (range, 2.5-4.5 months). The quality of postoperative fracture reduction was evaluated accord?ing to Matta’s standard, of which there were 7 cases anatomic, 3 cases satisfactory, and 2 cases unsatisfactory, with an anatomic or satisfactory rate of 83.3%(10/12). The average Matta’s improved Merle d’Aubigne?Postel score was 16.1 (range, 12-18), and there were 8 cases excellent, 2 cases good, 1 case fair and 1 case poor, with an excellent or good rate of 83.3%(10/12). Rupture of the peritoneum occurred in one patient during the surgery which was repaired immediately. One patient suffered obturator nerve palsy and was fully recovered in one year. No inguinal hernia, surgical site infection and femoral head avascular necrosis occurred. Con?clusion The combined plates could provide simultaneous fixation for anterior column and anterior wall fractures firmly through single superior?ilioinguinal approach. Satisfactory reduction and functional outcomes could be achieved by the novel plates.
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Objective To evaluate the efficacy and safety of 3D printing patient-specific external guide template in assisting minimally invasive screwing for treatment of pelvic and acetabular fractures.Methods The clinical and follow-up data of 39 pelvic or acetabular fractures were retrospectively analyzed which had been treated from June 2016 to February 2018 at Department of Orthopaedics,Wuhan Union Hospital.The patients were divided into a template group and a freehand group.In the template group,there were 14 men and 7 women with an age of 46.3 ± 18.2 years and 17 pelvic fractures and 4 acetabular fractures;in the freehand group,there were 12 men and 6 women with an age of 43.8 ± 12.2 years and 14 pelvic fractures and 4 acetabular fractures.The 2 groups were compared in terms of operation time,fluoroscopic frequency,guide wire adjustments,fracture reduction,screw penetration rate,function evaluation and adverse events.Results All the 39 patients were followed up for 9 to 13 months (average,11.6 months).A total of 42 screws were placed in the template group and 35 screws in the freehand group.The values of operation time (43.8 ± 22.2 min),fluoroscopic frequency (29.6 ± 10.7 times) and guide wire adjustments (1.8 ± 1.2 times) in the external guide template group were all significantly lower than those in the freehand group (73.8 ±22.6 min,54.6 ± 16.5 times and 9.8 ±2.8 times,respectively) (P ＜0.05).There were no significant differences between the 2 groups in screw penetration rate,rate of satisfactory reduction,Majeed scores for pelvic function or modified Merle d'Aubigné scores at the last follow-ups (P ＞ 0.05).One case in the freehand group experienced numbness after operation on unilateral dorsi pedis which disappeared at 3-month follow-up.Conclusion The 3D printing patient-specific external guide template can reduce fluoroscopic frequency,save operation time and improve accuracy of screw insertion,providing a new means for minimally invasive treatment of pelvis and acetabular fractures.
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Objective To explore the clinical effectiveness and reliability of combined acetabular quadrilateral surface plates for the treatment of both column fractures.Methods From June 2016 to August 2017,data of 15 cases with acetabular both column fractures who were treated in our department were retrospectively analyzed.Among them 9 cases were male and 6 were female.The mean age was 42.8 years (range,26-68 years).All cases were both column fractures according to the LetournelJudet's classification,including 4 cases combined with posterior wall fracture.Before operation,the pelvic CT thin layer scanning data of patients were collected in DICOM format,and then the data were imported to print the simulated model by 3D printing technology in order to understand the characteristics of fracture directly.The contralateral half pelvis was mirror printed in order to simulate the placement of combined quadrilateral surface plates and preshape all plates.During operation,infrapectineal main plate,pubo-ischiatic plate and ilio-ischiatic plate were placed consequently to fix the anterior column,"middle column" and posterior column respectively.The pubo-ischiatic and ilio-ischiatic plates were combined with the main plate.All cases were operated by supra-ilioinguinal approach.Results The average incision length was 11 cm (range,9-13 cm).The average operative time was 150 min (range,100-240 min).The average blood loss was 850 ml (range,600-1500 ml).Once reduction was obtained,plates could be placed easily and adhere to bone surface well.The quality of postoperative fracture reduction was evaluated according to Matta standard,of which there were 9 cases excellent,4 cases good,and 2 cases poor,with an excellent rate of 86.7％ (13/15).All patients were followed up for an average time of 10 months (range,6-12 months).At the latest follow-up,the average modified Merle d'Aubigne and Postel score was 16.4 (range,12-18),and there were 8 cases excellent,4 cases good,2 cases fair and 1 case poor,with an excellent rate of 80.0％ (12/15).Conclusion For the treatment of acetabular both column fractures,the combined quadrilateral surface plates could resist the medial displacement of quadrilateral area,and on the other hand the total floating posterior column and ischium could be fixed firmly.At the same time,this plate system is a multi-dimensional framework fixation,which is more effective and safer with lower complications rate,resulting in a satisfactory clinical outcomes.
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Objective To investigate the feasibility and efficacy of combinational acetabular quadrilateral surface plates in treating elderly patients with acetabular fractures.Methods A retrospective case series study was conducted on the clinical data of eight elderly patients with acetabular fractures admitted between August 2016 and June 2017.There were five males and three females,with an average age of 64.2 years (range,60-68 years).According to the Letournel-Judet's classification,there were four patients with both column fractures,two T-shaped fractures,two anterior column and posterior hemitransverse fractures,among which three were combined with posterior wall fractures.Before operation,the artificial pelvis model was prepared by 3D printing for simulating the placement of combinational plates in the quadrilateral surface,and the plates were shaped for operation use.During operation,through the high iliac inguinal approach,the infrapectineal plate,pubo-ischiatic plate,and ilio-ischiatic plate were placed successively to fix anterior column," middle column",and posterior column,respectively.The pubo-ischiatic and ilio-ischiatic plates were combined with the infrapectineal plate.After fracture reduction,internal fixation was completed at one time.The incision length,operation time,and intraoperative blood loss were recorded.Postoperative fracture reduction was evaluated by Matta standard,and function of hip joint by modified Merle d'Aubigné and Postel scoring system.The complications were recorded.Results All the patients were followed up for 3 12 months (mean,6.8 months).The average incision length was 10 cm (range,8-12 cm).The average operation time was 130 min (range,100-180 min).The average blood loss was 600 ml (range,350-1 000 ml).According to the Matta standard,six patients got excellent result,one good,and one fair,with an excellent and good rate of 7/8.With respect to the hip joint function at the last follow up,the result was excellent in four patients,good in two,fair in one and bad in one,with an excellent and good rate of 6/8.No iatrogenic vascular injury,inguinal hernia or pulmonary embolism occurred during operation.No traumatic arthritis or avascular necrosis of femoral head occurred after operation.Conclusions The fixation from inside to outside by using combinational quadrilateral surface plates is in accordance with the biomechanical characteristics of hip joint,which enables better function recovery,especially for elderly patients with acetabular fractures involving quadrilateral surface.Combined with 3D printing technique for preoperative planning,it can reduce operation time,blood loss and postoperative complications.
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Objective To investigate the clinical efficacy of a novel acetabulum anatomic locking plate in the treatment of anterior wall and anterior column acetabular fracture.Methods A retrospective case series study was performed in five patients with anterior wall and anterior column acetabular fractures managed operatively using a novel acetabulum anatomic locking plate from March 2014 to January 2016.There were four males and one female,with an average age of 41.1 years (range,25-65 years).The mean time from injury to operation was 3.2 days (range,2-5 days).All patients were managed operatively using the superior ilioinguinal approach.Operation duration,intraoperative blood loss,blood transfusion,and bony union time were recorded.The image results by Matta standard were evaluated and the acetabular function after operation was assessed by modified Merle d'Aubigné-Postel.Postoperative complications were recorded.Results All patients were followed up for average 15.3 months (range,12-24 months).The average operation duration was 96 minutes (range,60-130 minutes) and average blood loss was 230 ml (range,100-800 ml).Autologous blood transfusion was selectively used except for one patient with allogeneic blood transfusion of 400 ml.The mean time of bony union was 2.9 months (range,2-5 months).According to the Matta criteria,four patients attained anatomical reduction,and unsatisfactory reduction was reported in one patient.Clinical outcomes (Merled'Aubigné-Postel) at 12 months were 100％ excellent with the average score of 17.1 (range,15-18).One patient had a lateral cutaneous nerve palsy,and symptom relief was seen after a follow up of 6 months.After operation,no complications such as surgical site infection,femoral head avascular necrosis,andtraumatic arthritis occurred in any patient.Conclusion The novel acetabulum anatomic locking platecan provide rigid and firm fixation for both anterior wall and anterior acetabular fractures using one singleplate,and the fracture reduction and function recovery are satisfactory.
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Objective To investigate the effect of autologous platelet rich plasma along with bone transportation in tibia defect.Methods This was a randomized single-blind placebo controlled clinical trial.From Jan 2013 to Mar 2015,28 patients (28 cases) suffering from tibia defect because of trauma or osteomyelitis were randomly assigned to PRP group (PRP along with bone transportation,n=15) or bone transportation group (bone transportation only,n=13) through random number table and sealed envelop method.PRP group:male to female 12∶3,average age:40.9 years old,average bone defect:7.1 cm,6 caused by trauma,9 by osteomyelitis;while bone transportation group:male to female 10∶3,average age:37.7 years old,average bone defect:6.5 cm,3 caused by trauma and 10 by osteomyelitis.Bony results and tibia function were evaluated according to the Association of the Study and Application of the Method of Ilizarov (ASAMI) protocol.The external fixation index,complications and VAS pain score were also evaluated.Results The mean follow-up time was 21.8 m in PRP group and 23.2 m in bone transportation group and there were no loss to follow-up.There were no differences between two groups on postoperative VAS pain score:1st d postoperative (3.33±2.58 vs 4.46±2.73);7th d postoperative (2.67±2.09 vs 3.00±2.20);and 2 weeks postoperative (1.46± 1.77 vs 2.62±2.72).There was significant difference between two groups on external fixation index (37.9±7.7 d/cm vs 46.9± 13.7 d/cm).According to the ASAMI protocol,all patients achieve bone union,except 2 cases in control group which need revision surgery;excellent and good rate of bone defect union was 93％ in PRP group while 77％ in control group;while no difference was found on complication and lower extremity function.Conclusion Application of PRP along with bone transportation in the treatment of tibia defect resuits in shorter healing duration and external fixation duration.But no short-term postoperative analgesic effect,lower extremity function,and complication rates were found.
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Objective To explore the design of a novel acetabulum anatomic locking plate and the clinical application for both column and quadrilateral surface fractures.Methods Clinical and follow-up data of 6 patients with both column fractures involving the quadrilateral plate managed operatively by a novel acetabulum anatomic locking plate from July 2014 to April 2015 were retrospectively analyzed.Among them 4 cases were male and 2 cases were female,with an average age of 35.1 years old (range,24-52 years old).The mean time from injury to operation was 7.2 d (range,2-12 d).According to the fracture classification of Letournel-Judet,there were all associated with two column fractures involving the quadrilateral plate..All patients managed operatively by the novel acetabulum anatomic locking plate,which can simultaneous manage both column and quadrilateral surface fractures through the single superior ilioinguinal approach.The image results by Matta standard were evaluated and the results of acetabular function after surgery were assessed by Merle d'Aubigne-Postel.Results The 6 patients were followed up for at least 14 months (range,12-22 months).Average blood loss was 860 ml,and average operative time was 286 min.The mean time of bony union was 4.3 months.According to the criteria described by Matta,66.7％ of the reductions were graded excellent,16.7％ were graded good,and 16.7％ were poor.Clinical outcomes (Merle d'Aubigne-Postel) at 12 months were 66.7％ excellent,16.7％ good,and 16.7％ poor.One patient (4.5％) had an iatrogenic injury of internal iliac artery during operation.Unilateral iliac artery embolization was performed.One patient had a fatty fluidization.No surgical site infection,femoral head avascular necrosis and traumatic arthritis occurred.Conclusion The novel acetabulum anatomic locking plates for both column and quadrilateral surface can provide strong and stable fixation for complex acetabular fractures through the single superior ilioinguinal approach.It can achieve satisfactory reduction and approving clinical functions.
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Objective To investigate the clinical outcomes in the treatment of complex acetabular fractures through a single supra-ilioinguinal approach after the application of preoperative 3D printing and rapid prototyping simulating the operative procedure.Methods From January 2013 to January 2016,24 cases of complex pelvic and acetabular fractures in our hospital were retrospectively analyzed.Among them 18 cases were male and 6 were female.The average age was 39.2+±13.8 years (range,24-68 years).According to Letoumel-Judet's classification,there were 6 cases of transverse,4 cases of T shaped,4 cases of combined anterior column and posterior hemi-transverse (ACPHT) and 10 cases of 2-column fractures.The time from injured to operation averaged 9 days (range,4-18 days).Before operation,pelvic AP view,three-dimensional CT as well as CTA of iliac blood vessels was taken routinely in all cases.The CT and CTA scan data were then imported into Mimics software for 3D reconstruction.Surgical simulation and optimal placement of internal fixations were performed on computer.After that,the individual simulated model of the pelvis was printed by the use of 3D printing and rapid prototyping technique.The order of reduction,selection and optimal position of the implants were determined.The plates were bent before operation and the length and direction of the screws were recorded.A uniform supra-ilioinguinal approach was used in all cases.Results The length of incision averaged 9 cm (range,8-13 cm).The operative time average 130 min (range,90-220 min).The blood loss averaged 600 ml (range,300-1 500 ml).Once a satisfactory reduction was obtained,single placement of the plates was achieved.In accordance with the preoperative plan,the plates were perfectly fitted to the bone surface.The 24 patients were followed for an average time of 18.3 months (range,15-30 months).The fractures healed in all cases.The average healing time was 4.2 months (range,3-6 months).According to Matta criteria,there were 16 cases of excellent,6 cases of good,2 cases of poor and the excellent rate was 91.7％ (22/24).The average modified Merle d'Aubigne score was 16.5 (range,13-18).The functional outcome was excellent in 13 cases,good in 6 cases and poor in 5 cases.The excellent rate of hip functions was 79.2％ (19/24).There were 2 cases of femoral lateral cutaneous nerve injury (recovered one month later) and another 1 case of fat liquefaction of the incision happened three days postoperatively (the wound healed completely after several dressing changes).No inguinal hernia or abdominal wall hemias was found.No other postoperative complications was found.Conclusion The application of 3D printing and rapid prototyping technique allows preoperatively simulating reduction in vitro,determining the optimal position of the implants,bending the plates and measuring the length of the screws in advance,which could largely reduce the operative time,intraoperative blood loss and occurrence of postoperative complications.Adopting supra-ilioinguinal approach for the treatment of complex acetabular fractures with a small incision and less trauma,a full exposure could be obtained,so the reduction and fixation of the anterior,posterior and middle column (also named pubo-ischiatic column) could be completed in a direct visualization,resulting in a satisfactory clinical outcomes.