Treatment of complex quadrilateral surface fractures of the acetabulum by internal fixation with dynamic anterior plate-screw system / 中华创伤骨科杂志

ABSTRACT

Objective To explore the clinical efficacy of internal fixation with dynamic anterior plate-screw system for quadrilateral area(DAPSQ) in the treatment of complex acetabular fractures involving the quadrilateral surface.Methods Between January 2005 and January 2017,a series of 143 patients with complex quadrilateral surface fracture of the acetabulum were treated at Department of Orthopaedics,General Hospital of Central Theater Command.They were 86 males 57 females,with a mean age 46.6 years (range,from 19 to 77 years).By the Letournel-Judet classification,there were 38 anterior column plus posterior hemitransverse fractures,26 T-shaped fractures and 79 double column fractures.They were all closed.The delay from injury to surgery averaged 9.6 days(range,from 3 to 21 days).All the cases were treated with DAPSQ internal fixation via the ilioinguinal approach.Their operation time,intraoperative bleeding volume,quality of fracture reduction,hip function and complications were recorded.Results The operation time for this series ranged from 2.5 to 5.0 hours,averaging 3.8 hours.The intraoperative blood bleeding ranged from 400 to 2,500 mL,with an average of 680 mL.By the Matta criteria for fracture reduction,76 cases were rated as excellent,51 as good and 16 as poor,giving an excellent and good rate of 88.8％.The 143 patients were followed up from 4 months to 10 years (mean,4.1 years).The clinical fracture union was achieved after 2 to 4 months (mean,3 months).By the modified Merle d'Aubigné & Postel criteria,the affected hips scored 9 to 18 points (mean,16.3 points) at the final follow-ups,with 64 excellent,52 good,19 fair and 8 poor cases,giving an excellent and good rate of 81.1％.The postoperative complications included lesion of lateral femoral cutaneous nerve in 7 cases,urinary tract infection in 15 ones,traumatic osteoarthritis in 20 ones 5 of whom had to receive total hip arthroplasty,and heterotopic ossification (Brooker Grade Ⅰ) in 5 ones.Conclusion Internal fixation with DAPSQ is safe and effective for the treatment of complex acetabular fractures involving the quadrilateral surface.