ABSTRACT
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.