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Freude T, Gänsslen A, Krappinger D, Lindahl J. Quadrilateral plate fractures. Arch Orthop Trauma Surg 2024; 145:51. [PMID: 39680200 DOI: 10.1007/s00402-024-05698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/28/2024] [Indexed: 12/17/2024]
Abstract
During the last two decades, extended scientific interest focused on quadrilateral plate (QLP) fractures as part of common acetabular fractures. The QLP corresponds to the medial wall of the acetabulum, and different fracture pattern of Letournel´s fracture types are associated with concomitant QLP fractures. Except anterior and posterior wall fractures, all other fracture types may be associated with QLP fractures. QLP fracture features include simple fracture lines up to highly comminuted fractures. A detailed preoperative analysis of these fractures is important to get a better understanding of intraoperative decision making. No consensus exists regarding the optimal classification and treatment of QLP fractures. Various operative approaches and treatment concepts exists depending on the specific QLP fracture type and the acetabular fracture type. Several new implants were development for optimal but often individual stabilization concepts. The gold-standard is still some medial buttressing during internal fixation predominantly using plates, but also screw fixation is considered an option. Additional dome impactions must be considered as an integral part in any QLP fracture analysis and stabilization.
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Affiliation(s)
- T Freude
- University Hospital for Orthopaedics and Traumatology, Müllner Hauptstraße 48, Salzburg, A-5020, Austria
| | - Axel Gänsslen
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany.
- Department of Trauma and Orthopedics, Johannes Wesling Hospital, Minden, Germany.
| | - D Krappinger
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, Innsbruck, A-6020, Austria
| | - J Lindahl
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Lan S, Meng C, Yuan G, Wang G, Liu X, Cai X. Fractures of the quadrilateral plate treated with a reconstruction plate and trans-plate quadrilateral screws: An experimental study on cadaveric specimens and finite element analysis. Medicine (Baltimore) 2024; 103:e40850. [PMID: 39686433 DOI: 10.1097/md.0000000000040850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2024] Open
Abstract
Quadrilateral plate fracture is one of the most complex and challenging pelvic lesions. Operative reduction and internal fixation are the gold standard management for displaced quadrilateral plate fractures. Traditional methods include various kinds of operative reduction and internal fixation through either anterior or posterior approaches using various combinations of plates and lag screws or acute total hip arthroplasty. Here we introduced a new fixation technique named reconstruction plate combined with trans-plate quadrilateral screws. We performed a cadaveric study to determine the biomechanical properties of this system comparing with conventional titanium plate combined with 1/3 tube titanium plate in a both-column acetabular fracture model in standing position. Besides, a finite element model of both-column acetabular fractures fixed by this system was developed and the mechanical properties of implants and acetabular fractures were analyzed. The biomechanical test showed the superiority of reconstruction plate combined with trans-plate quadrilateral screws over conventional titanium plate combined with 1/3 tube titanium plate in treating both-column quadrilateral plate fractures in standing position. Later finite element analysis confirmed the stabilities of the fractures under 1-legged stance. Thus, reconstruction plate combined with trans-plate quadrilateral screws provides an alternative method in treating quadrilateral plate fractures.
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Affiliation(s)
- Shenghui Lan
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Chengfei Meng
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Gongwu Yuan
- Department of Orthopaedics, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Guodong Wang
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Ximing Liu
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Xianhua Cai
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
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Gänsslen A, Freude T, Lindahl J, Krappinger D. Articular impactions in acetabular fractures. Arch Orthop Trauma Surg 2024; 145:20. [PMID: 39666029 PMCID: PMC11638304 DOI: 10.1007/s00402-024-05611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 10/01/2024] [Indexed: 12/13/2024]
Abstract
Impactions of the articular surface are relevant prognostic parameters in the treatment of acetabular fractures. Posterior marginal impactions and acetabular dome impactions may occur depending on the direction of the force vectors during trauma. Posterior marginal impactions are mainly observed in posterior fracture dislocations, while acetabular dome impactions are frequently seen in the elderly with the hip joint in extension during trauma. Femoral head impactions are also frequently associated with acetabular fractures, mainly in fracture dislocations and transverse acetabular fractures. CT scans using thin slices are mandatory in order to preoperatively identify acetabular and femoral head impactions. Intraoperatively, the reduction techniques depend on the type of marginal impaction. Posterior impactions are usually addressed via a posterior approach by applying femoral traction under direct visualization or even by performing surgical hip dislocation. Acetabular dome impactions may be reduced using the fracture lines or by creating a cortical window. Reduction is followed by filling the void with bone or bone substitutes supported by raft screws. No clear treatment recommendations for femoral head impactions are given in the literature.
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Affiliation(s)
- Axel Gänsslen
- Trauma Department, Hannover Medical School, Hannover, Germany
- Department of Trauma and Orthopedics, Johannes Wesling Hospital, Minden, Germany
| | - Thomas Freude
- University Hospital for Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Jan Lindahl
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Dietmar Krappinger
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Gulija J, Žigman T, Dobrić I, Bobovec D, Gusić N. Isolated quadrilateral plate fracture with central hip dislocation after epileptic seizure in a postpartum patient: A case report. Chin J Traumatol 2024; 27:410-413. [PMID: 37652792 PMCID: PMC11624303 DOI: 10.1016/j.cjtee.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/01/2023] [Accepted: 06/20/2023] [Indexed: 09/02/2023] Open
Abstract
Isolated quadrilateral plate fractures are extremely rare and their treatment is complex. The postpartum period and recent caesarean section additionally increase already significant risks of surgical treatment. Modified Stoppa approach and the use of infrapectineal plate represent the optimal surgical treatment method. One case of central hip dislocation and isolated quadrilateral plate fracture was reported during an epileptic seizure 1 day postpartum, which was treated with open reduction and internal fixation. A 25-year-old female patient had given birth via cesarean section. One day postpartum, she had multiple generalized tonic clonic seizures. Arteriovenous malformation was identified as the cause of seizures by MRI. The patient complained of left hip pain and inability to move the left leg which prompted clinical and radiological examination. A pelvic CT scan verified multifragmentary fracture of the quadrilateral plate without fracture of the acetabular columns. The central hip dislocation was verified. Due to the rarity of the fracture, the clinical decision-making process was difficult. The patient, being in the postpartum period, was also at a greater risk of infection. The patient was treated surgically, and osteosynthesis was performed with an infrapectineal plate for the acetabulum using the modified Stoppa approach. The initial incision was done through the same Pfannenstiel incision from caesarean section. The patient's postoperative recovery was good at 1 year follow-up.
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Affiliation(s)
- Jana Gulija
- School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
| | - Tomislav Žigman
- School of Medicine, University of Zagreb, Zagreb, 10000, Croatia; Department of Surgery, University Hospital Centre Zagreb, Zagreb, 10000, Croatia.
| | - Ivan Dobrić
- School of Medicine, University of Zagreb, Zagreb, 10000, Croatia; Department of Surgery, University Hospital Centre Zagreb, Zagreb, 10000, Croatia
| | - Dino Bobovec
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, 10000, Croatia
| | - Nadomir Gusić
- Department of Surgery, Pula General Hospital, Pula, 52100, Croatia
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Ahmadi MA, Moein SA, Fereidooni R, Ayatizadeh SH. Use of calcaneal locking plate in surgical treatment of quadrilateral plate fractures of the acetabulum. Musculoskelet Surg 2024; 108:431-436. [PMID: 38814429 DOI: 10.1007/s12306-024-00830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Specialized devices for fixation of the acetabulum quadrilateral plate (QP) fractures may not be readily available in resource-constrained settings. In this article, we aim to explore the use of a 3.5-mm locking calcaneal plate in fixation of QP fractures. METHODS Twenty-eight patients with QP fractures underwent surgery using the modified Stoppa approach. Follow-up at 12 months assessed fracture healing and functional outcomes using the Majeed pelvic outcome score. Descriptive statistics summarized patient demographics and fracture characteristics. Analysis of variance (ANOVA) and exact logistic regression explored associations between factors (age, AO/OTA classification, gender, and time to surgery) and Majeed scores. RESULTS The mean age of patients was 42.71 years, with the majority being male (64.29%). All patients achieved bony union. Post-traumatic arthritis developed in three patients, while two patients experienced post-operative fracture redisplacement. Evaluation using the Majeed pelvic outcome score revealed generally favorable outcomes, with 32.14% achieving excellent, 39.29% good, 21.43% fair, and 7.14% poor outcome. Only an older age was associated with a worse outcome score (excellent/good versus fair/poor, odds ratio: 0.87, 95% confidence interval: 0.77, 0.96). CONCLUSION Surgical management of quadrilateral plate fractures using 3.5-mm locking calcaneal plates demonstrates promising outcomes, particularly in resource-constrained settings, where specialized devices may be lacking.
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Affiliation(s)
- Mohammad Amin Ahmadi
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Arman Moein
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Reza Fereidooni
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Hamidreza Ayatizadeh
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Bannister DA, Yong TM, Morris CA, Collinge CA, Mitchell PM. Pathoanatomy of the anterior column-posterior hemitransverse acetabular fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 35:10. [PMID: 39567398 DOI: 10.1007/s00590-024-04122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 10/26/2024] [Indexed: 11/22/2024]
Abstract
PURPOSE To define the pathoanatomy of the anterior column-posterior hemitransverse (ACPHT) subtype of acetabulum fractures and assess the morphologic variation therein. METHODS Retrospective cohort study including 50 patients age greater than 60 with an ACPHT acetabular fracture managed operatively over an 11-year period at an ACS Level 1 Trauma center. Cross-sectional CT images were reviewed for anterior column/wall comminution, anterior column fracture exit point, completeness of the anterior column and posterior column fractures, articular impaction and quadrilateral surface continuity with the posterior column. RESULTS Comminution of the anterior column/wall was seen in 60% of patients. The anterior column fracture line exit was variable and exited below the anterior inferior iliac spine (AIIS) in 36% of fractures, at the AIIS or between the iliac spines in 40%, and through the iliac crest in 24%. A complete fracture was present in 72% of anterior column fractures and 44% of posterior column fractures. Impaction of the acetabular joint surface was present in 84% of patients. Continuity of the quadrilateral surface with the posterior column was present in 60% of cases. CONCLUSIONS Significant variability exists within the ACPHT fracture pattern. Understanding the variability within the ACPHT subtype is critical for adequately analyzing these patterns and has implications in future biomechanical studies and implant design. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Dalton A Bannister
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA
| | - Taylor M Yong
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA
| | - Cade A Morris
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA
| | - Cory A Collinge
- Department of Orthopedic Trauma, Harris Methodist Fort Worth Hospital, Fort Worth, TX, 76104, USA
| | - Phillip M Mitchell
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21St Avenue South, Nashville, TN, 37232, USA.
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Khamis AR, Esmat EE, Massè A, Elzeiny A, Hamed H. Clinical and radiographic results of internal fixation of quadrilateral plate fractures of acetabulum. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3599-3607. [PMID: 38960903 DOI: 10.1007/s00590-024-04033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Quadrilateral plate (QLP) is a relatively thin bony structure located below the pelvic brim proximal to the hip joint, so management of its fractures is challenging. OBJECTIVES Evaluation of the functional and radiological outcomes of internal fixation of quadrilateral plate acetabular fractures; comparison of two methods of fracture fixation. PATIENTS AND METHODS A prospective multicentric study including 30 patients who underwent open reduction and internal fixation of QLP fractures through modified Stoppa approach. Patients were divided into two groups according to the method of fixation (anatomical QLP plate vs suprapectineal and infrapectineal plates). Post-operative quality of reduction was evaluated using Matta score. Radiographical assessment according Matta's grading criteria and clinical outcome assessment using the Harris Hip Score (HHS) were repeated at follow-up and at one year to assess displacement. RESULTS Mean age of patients was 34.9 ± 12.1 years. After one year follow-up, clinically mean HHS was 88. ± 5.74. Radiologically post-operative reduction quality was anatomical in 21 (70%) patients, satisfactory in eight (26.7%) patients and unsatisfactory in one (3.3%) patient. Matta's grading at the last follow-up was excellent in 21 (70%) patients, good in six (20%), fair in two (6.7%) patients and poor in one (3.3%) patient. No significant difference was recorded between the two groups in terms of radiographical and clinical results and rate of complications. CONCLUSION Accurate reduction of quadrilateral plate fracture with secure fixation through modified Stoppa approach provides good and reproducible outcomes with few complications regardless the type of the implant.
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Affiliation(s)
- Ahmed Refaat Khamis
- Department of Orthopaedics and Traumatology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Emad Eldin Esmat
- Department of Orthopaedics and Traumatology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Alessandro Massè
- Department of Orthopaedic Surgery, Centro Traumatologico Ortopedico (CTO), University of Turin, Turin, Italy
| | - Ahmed Elzeiny
- Department of Orthopaedics and Traumatology, Kafr El Sheikh Faculty of Medicine, Kafr El Sheikh University, Kafr Elsheikh, Egypt.
| | - Hany Hamed
- Department of Orthopaedics and Traumatology, Kafr El Sheikh Faculty of Medicine, Kafr El Sheikh University, Kafr Elsheikh, Egypt
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Freude T, Krappinger D, Lindtner RA, Stuby F. The Pararectus approach: a preferred surgical approach for fixation of acetabular fractures predominantly involving the anterior column - a narrative review. Arch Orthop Trauma Surg 2024; 144:4541-4547. [PMID: 39078483 DOI: 10.1007/s00402-024-05455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/03/2024] [Indexed: 07/31/2024]
Abstract
Beginning in France in the 1960s, the management of acetabular fractures has increasingly evolved toward surgical treatment strategies. The basic principles established by the pioneers of acetabular surgery, Letournel and Judet - anatomical reconstruction of the joint and stable osteosynthesis - remain unchanged. Modern advancements in surgical techniques aim to reduce access-related trauma and minimize complications. The notable rise in acetabular fractures among the elderly, which predominantly affect the anterior aspects of the acetabulum, has driven the development of less invasive, soft tissue-sparing anterior approaches. This evolution began with the ilio-inguinal approach in the 1960s, progressed to the modified Stoppa approach in the 2000s and, most recently, the Pararectus approach in the 2010s. Each of these approaches upholds the fundamental principles of effective acetabular fracture care, while offering distinct advantages and disadvantages. In this review, we examine the merits and limitations of the Pararectus approach, specifically focusing on its utility in the surgical treatment of anterior column posterior hemitransverse acetabular fractures. Ultimately, the success of the individual patient's outcome is less dependent on the chosen approach and more on the surgeon's experience and expertise. Ideally, surgeons should be proficient in all these approaches to tailor the surgical strategy to the individual patient's requirements, thereby ensuring optimal outcomes.
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Affiliation(s)
- Thomas Freude
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Dietmar Krappinger
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard A Lindtner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Fabian Stuby
- Department of Traumatology and General Surgery, BG Unfallklinik Murnau, Murnau Am Staffelsee, Germany
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Hinz N, Baumeister D, Dehoust J, Münch M, Frosch KH, Augat P, Hartel MJ. The infraacetabular screw versus the antegrade posterior column screw in acetabulum fractures with posterior column involvement: a biomechanical comparison. Arch Orthop Trauma Surg 2024; 144:2573-2582. [PMID: 38676740 PMCID: PMC11211174 DOI: 10.1007/s00402-024-05324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Traditionally, plate osteosynthesis of the anterior column combined with an antegrade posterior column screw is used for fixation of anterior column plus posterior hemitransverse (ACPHT) acetabulum fractures. Replacing the posterior column screw with an infraacetabular screw could improve the straightforwardness of acetabulum surgery, as it can be inserted using less invasive approaches, such as the AIP/Stoppa approach, which is a well-established standard approach. However, the biomechanical stability of a plate osteosynthesis combined with an infraacetabular screw instead of an antegrade posterior column screw is unknown. MATERIAL AND METHODS Two osteosynthesis constructs were compared in a synthetic hemipelvis model with an ACPHT fracture: Suprapectineal plate + antegrade posterior column screw (APCS group) vs. suprapectineal plate + infraacetabular screw (IAS group). A single-leg stance test protocol with an additional passive muscle force and a cyclic loading of 32,000 cycles with a maximum effective load of 2400 N was applied. Interfragmentary motion and rotation of the three main fracture lines were measured. RESULTS At the posterior hemitransverse fracture line, interfragmentary motion perpendicular to the fracture line (p < 0.001) and shear motion (p < 0.001) and at the high anterior column fracture line, interfragmentary motion longitudinal to the fracture line (p = 0.017) were significantly higher in the IAS group than in the APCS group. On the other hand, interfragmentary motion perpendicular (p = 0.004), longitudinal (p < 0.001) and horizontal to the fracture line (p = 0.004) and shear motion (p < 0.001) were significantly increased at the low anterior column fracture line in the APCS group compared to the IAS group. CONCLUSIONS Replacing the antegrade posterior column screw with an infraacetabular screw is not recommendable as it results in an increased interfragmentary motion, especially at the posterior hemitransverse component of an ACPHT fracture.
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Affiliation(s)
- Nico Hinz
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
| | - Dirk Baumeister
- Institute for Biomechanics, BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Matthias Münch
- Laboratory for Biomechanics, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Maximilian J Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
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Chongshuai B, Xuhang Y, Li H, Qingshuang Y, Lin C, Jun A. Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: an anatomical-morphological study. BMC Musculoskelet Disord 2024; 25:417. [PMID: 38807120 PMCID: PMC11135013 DOI: 10.1186/s12891-024-07522-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population. METHODS Pelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20 and 60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure. RESULTS The combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P < 0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P < 0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P < 0.05). The bending angle (< A) was also significantly smaller in females (P < 0.05). CONCLUSIONS The pelvic surface structure is irregular and varies greatly among individuals.Compared to the traditional steel plate, The combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis.
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Affiliation(s)
- Bao Chongshuai
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Yan Xuhang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - He Li
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Yao Qingshuang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Chen Lin
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
| | - Ao Jun
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
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Kilinç CY, Gültaç E, Can Fİ, Kilinç RM, Şener B, Açan AE. Comparison of 2 different fixation techniques of comminuted acetabular quadrilateral surface fractures using square bracket-shaped tubular plate or interfragmentary screws in addition to supra/infrapectineal plate fixation: An observational study. Medicine (Baltimore) 2024; 103:e38252. [PMID: 38758854 PMCID: PMC11098240 DOI: 10.1097/md.0000000000038252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
The management of comminuted quadrilateral fractures remains challenging, and treatment options are constantly evolving. The purpose of the present study was to examine the outcomes of 2 different fixation techniques in the management of comminuted quadrilateral fractures. Twenty-two patients with comminuted quadrilateral acetabular fractures were surgically treated with interfragmentary lag screw (group 1) and square bracket-shaped tubular (SBST) plate technique (group 2), in addition to suprapectineal and infrapectineal pelvic reconstruction plate fixation between January 2016 and July 2019 at our clinic. 2 years follow-up control data of each group were compared in terms of radiological and functional results, and complications. According to the functional score comparison, the mean Merle d'Aubigne Postel scoring system (MAP) score was 15.2/15.6 (P = .632), and the mean Harris hip scoring (HHS) system score was 74.65/77.3 (P = .664) in groups 1 and 2, respectively. Radiological comparison was performed according to matta radiological criteria (MRC), and 2 excellent, 6 good, 2 poor, 4 excellent, 4 good, and 4 poor radiological results were observed in groups 1 and 2, respectively. intraarticular screw penetration was detected in 3 patients in group 1, while there was no articular implant penetration in group 2 (P = .001). We believe that satisfactory results can be obtained with the SBST plate technique, offering functional and clinical outcomes that are similar to those of the interfragmentary screw technique. The SBST plate technique is superior in terms of avoiding intraarticular screw penetration and related revision surgery.
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Affiliation(s)
| | - Emre Gültaç
- Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Fatih İlker Can
- Mugla Training and Research Hospital Orthopedics and Traumatology Clinic, Mugla, Turkey
| | - Rabia Mihriban Kilinç
- Department of Radiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Burak Şener
- Mugla Training and Research Hospital Orthopedics and Traumatology Clinic, Mugla, Turkey
| | - Ahmet Emrah Açan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
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Ardiansyah A, Dilogo IH, Gunawan B, Oesman I, Herlambang D. Functional, radiological, and quality of life outcome of unstable acetabular fracture with quadrilateral plate involvement at a tertiary care center in Jakarta, Indonesia. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1131-1140. [PMID: 37966556 DOI: 10.1007/s00590-023-03752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Unstable acetabular fracture remains a complex fracture that requires technically demanding surgery for orthopedic surgeons. Quadrilateral plate (QP) fractures of the acetabulum are a challenging group of acetabular fractures to manage. However, the literature regarding the management of these injuries are limited. The QP is a relatively thin medial wall of the acetabulum and intra-articular; thus, anatomical reduction and stable fixation are required for satisfactory outcome. This study aims to determine the functional, radiological, and quality of life outcome of unstable acetabular fracture with QP involvement. METHODS This was a retrospective cohort study conducted at Cipto Mangunkusumo General Hospital during the period of 2010-2020. Patients with unstable acetabular fractures with and without QP involvement were included in this study. They were followed up postoperatively at 1, 6, and 12 months. Functional outcome was assessed using the Harris Hip Score (HHS), Merle D'Aubigne, and Oxford Hip Score (OHS); while radiology outcome was assessed using Matta Outcome Grading; and quality of life was assessed using the SF-36. RESULTS This study involved 53 subjects with a median age was 29 (18-75) years of age. Twenty-eight (52.8%) subjects had unstable acetabular fracture with QP involvement. Twenty-five (47.2%) subjects had unstable acetabular fracture without QP involvement. Twenty-five (47.2%) subjects were fixed using quadrilateral hook plate, 3 (5.7%) with infrapectineal plate, 10 (18.8%) with posterior column plate, and 15 (28.3%) with suprapectineal plate. The median intraoperative bleeding in those with unstable acetabular fracture with QP involvement was 600 (300-4000) ml, which was higher than those without QP involvement (400 [100-1700] ml). Those with QP involvement achieved anatomical reduction in 20 (71.4%) subjects. Whereas, the subjects without QP involvement achieved anatomical reduction 23 patients (92%). Subjects with QP involvement had significantly lower functional, radiological, and quality of life outcomes compared to those without quadrilateral plate involvement based on Harris Hip Score (p = 0.046), Merle D'Aubigne (0.001), Oxford Hip Score (0.001), Matta Outcome Grading (0.004), and SF-36 (0.001). Patients with quadrilateral hook plate showed no significant functional, and radiological outcome difference compared to patients with infrapectineal plate based on Harris Hip Score (p = 0.582), Merle D'Aubigne (0.698), Oxford Hip Score (1.000), and Matta Outcome Grading (1.000). In addition, we also found no significant functional, radiological, and quality of life outcome difference between posterior column plate and suprapectineal plate group based on Harris Hip Score (p = 0.200), Merle D'Aubigne (0.643), Oxford Hip Score (0.316), Matta Outcome Grading (1.000), and SF-36 (0.600). CONCLUSIONS Patients with unstable acetabular fracture with quadrilateral plate involvement subject had significantly lower functional, radiological, and quality of life outcomes compared to those without quadrilateral plate involvement. Both quadrilateral hook and infrapectineal plates demonstrated non-significant functional and radiological outcomes difference. Posterior column plate also resulted in the same functional, radiological, and quality of life outcome compared with suprapectineal fixation.
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Affiliation(s)
- Ardiansyah Ardiansyah
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bambang Gunawan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ihsan Oesman
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Kim BS, Bae KC, Cho CH, Lee KJ, Lee IG, Lee MG, Min BW. Is the Direct Fixation of Displaced Quadrilateral Plates in Acetabular Fractures Necessary? J Clin Med 2023; 12:6994. [PMID: 38002609 PMCID: PMC10672613 DOI: 10.3390/jcm12226994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Quadrilateral plate fractures represent a heterogeneous group of acetabular fractures. Accurate reduction is required to prevent post-traumatic arthritis. The purpose of this study is to determine the reduction effect of the direct fixation of quadrilateral plates in acetabular fractures, and to evaluate the strength of direct fixation compared to indirect fixation. Between 2005 and 2021, 49 patients underwent surgery for open reduction and internal fixation in acetabular fractures with severely displaced quadrilateral plates. Twenty-nine patients comprised the indirect fixation group, and twenty patients comprised the direct fixation group. In a comparison of primary outcome between two groups, 10 out of 29 indirect-group patients and 1 out of 20 direct-group patients developed post-traumatic osteoarthritis, wherein the difference between the two groups is statistically significant. In the assessment of postoperative Matta's radiological reduction status, 19 out of 20 patients in the direct group had achieved anatomical and congruent reduction. The treatment using a direct reduction and internal fixation improved the reduction quality of articular displacement and offered a better survivorship of the affected hip joint.
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Affiliation(s)
- Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Kyung-Jae Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - In Gyu Lee
- Marine Corps Education & Training Group, Republic of Korea Marine Corps, Pohang 37896, Republic of Korea;
| | - Min-Gyu Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Byung-Woo Min
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
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Kanezaki S, Miyazaki M, Sakamoto T, Hino A, Abe T, Sako N, Tsumura H. Dome impaction classification in acetabular fractures: Identifying atypical dome impactions with absence of the gull sign: A retrospective descriptive study. Medicine (Baltimore) 2023; 102:e35523. [PMID: 37861513 PMCID: PMC10589566 DOI: 10.1097/md.0000000000035523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
We aimed to describe variations of dome impaction fractures and their characteristics using a new classification system, to explore the relationship between dome impaction and the gull sign. The present study was a retrospective descriptive study. All 104 cases of acetabular fracture that were treated in our institution from 2013 to 2022 were enrolled. Of these, 22 had dome impaction fractures. The primary outcome variable was to describe the variations and characteristics of dome impaction fractures. They were classified into 3 major subgroups based on reconstructed axial, coronal, and sagittal computed tomography findings: anteromedial, superomedial (SM), and posteromedial. The secondary outcome variable was to explore the relationship between dome impaction on computed tomography findings and the gull sign on plain radiographs. There were 4 cases of anteromedial (18.2%), 13 of SM (59.1%), and 5 of posteromedial (22.7%). There were 15 cases (68.2%) with the gull sign and 7 cases (31.8%) without the gull sign on plain radiographs. Twelve of fifteen cases (80.0%) with the gull sign had dome impaction fractures of the SM type. We found a variety of patterns of dome impaction fracture. Surgeons should be aware of atypical dome impactions not showing the gull sign.
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Affiliation(s)
- Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- Advanced Trauma, Emergency, and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tomonori Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- Advanced Trauma, Emergency, and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Akihiro Hino
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- Advanced Trauma, Emergency, and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Noriaki Sako
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Chen X, Wu H, Cheng K, Liu X, Cai X. Inclined angles of acetabular quadrilateral plate: digital measurement and clinical application of the new anatomical concept. J Orthop Surg Res 2023; 18:723. [PMID: 37749606 PMCID: PMC10518972 DOI: 10.1186/s13018-023-04143-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/27/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Matta scoring standard is one of the most frequently used postoperative imaging evaluations for acetabular fracture reduction, but has obvious shortcomings. This study, for the first time, proposed the concept of inclined angles of acetabular quadrilateral plate. The purpose of this study was to investigate the normal range of the inclined angles in adults by digital measurement and explore the feasibility of using them to evaluate the reduction quality of acetabular quadrilateral fractures after surgery. METHODS Firstly, the pelvic CT three-dimensional reconstruction data of 40 healthy adults including 20 males and 20 females were collected. The normal range of the anterior, middle, and posterior inclined angles were measured via Mimics software. Secondly, a modified Matta criteria that combined the classic Matta criteria and evaluation criteria of the inclined angles was proposed. And we classified modified Matta criteria into three grades including excellent, good and poor. Finally, a total of 125 cases with quadrilateral plate fractures was included and the postoperative CT data were analyzed by using both the classic Matta criteria and our modified Matta criteria. Then, the accuracy and consistency of both criteria to evaluate postoperative hip function was investigated. RESULTS The average anterior inclined angle: male (97.11° ± 2.59°), female (90.63° ± 2.09°); middle inclined angle: male (105.57° ± 1.93°), female (100.64° ± 2.46°); and posterior inclined angle: male (112.62° ± 2.54), female (106.37° ± 2.53°). Whether in males or in females, the anterior, middle, and posterior inclined angles showed a progressively increasing trend. All the three inclined angles in males were all significantly larger than those in females (p < 0.05). Among 125 cases with quadrilateral plate fractures, 101 cases (80.8%) were graded as excellent, 18 cases (14.4%) as good, and 6 cases (4.8%) as poor according to the classic Matta criteria. While based on modified Matta criteria, there were excellent in 37 cases (29.6%), good in 76 cases (60.8%), and poor in 12 cases (9.6%). According to the Harris hip score system, the functional outcomes were excellent in 59 cases (47.2%), good in 26 cases (20.8%), fair in 24 cases (19.2%), and poor in 16 cases (12.8%). Our results showed that among the cases evaluated as excellent according to the classic Matta criteria and modified Matta criteria, the excellent-to-good rates of hip function were 70.3% and 78.4%, respectively. And among the cases evaluated as poor according to the modified Matta criteria, the fair-to-poor rate of hip function was 75%, while this value was 50% for classic Matta criteria. Both differences were statistically significant (p < 0.05). CONCLUSION Inclined angles of the quadrilateral plate could be used to assess the quality of fracture reduction and provide a basis for evaluating the rotational displacement of fracture blocks in the quadrilateral plate, which compensates the shortage of classic Matta criteria.
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Affiliation(s)
- Xiaofeng Chen
- Department of Orthopaedic Surgery, Yangxin People's Hospital, Yangxin, 435200, Hubei, China
| | - Haiyang Wu
- Department of Clinical Medicine, Graduate School of Tianjin Medical University, Tianjin, 301700, China.
| | - Kunming Cheng
- Department of Intensive Care Unit, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430064, Hubei, China
| | - Xianhua Cai
- Department of Orthopaedic Surgery, South China Hospital Affiliated to Shenzhen University, Shenzhen, 518111, Guangdong, China.
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Chen K, Yao S, Yin Y, Wan Y, Ahn J, Zhu S, Chen H, Fan S, Guo S, Yi C, Li L, Hou Z, Guo X. A new classification for quadrilateral plate fracture of acetabulum. Injury 2023:S0020-1383(23)00389-3. [PMID: 37164901 DOI: 10.1016/j.injury.2023.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Recently, quadrilateral plate (QLP) fractures of acetabulum have attracted increasing attention. However, evidence for the appropriate classification of QLP fractures is still lacking, making it difficult to understand and manage these fractures. This study aimed to introduce a new classification for QLP fractures and evaluate its reproducibility. METHODS A series of 1101 consecutive patients with acetabular fractures from 8 level-I trauma centers were enrolled in this study. All patients underwent preoperative radiograph and computed tomography imaging. QLP fractures were identified and classified using the new and Judet-Letournel classification system. The inter- and intra-observer reliabilities (kappa coefficients, κ) of these two systems were investigated by 4 observers. Furthermore, surgical approaches and fixation methods for each fracture type are described. RESULTS In total, 243 (243/1101, 22%) patients with QLP fractures were identified and included in this analysis. The mean κ value of the intra-observer reliability was 0.84 (range, 0.763-0.919) for the new classification, indicating excellent agreement, and the inter-observer reliability was 0.762 (range, 0.625-0.876), indicating substantial agreement. The values were 0.649 (range, 0.523-0.708) and 0.584 (0.497-0.646), respectively, according to the Judet-Letournel classification. Six cases (6/243, 2.5%) could not be classified using the Judet-Letournel classification. The selection of surgical approaches and fixation methods depends on the fracture type; however, an anterior intra-pelvic approach and buttressing fixation using the plate or screw are preferred for QLP fractures. CONCLUSION This study presents a new classification for QLP fractures, showing higher intra- and inter-observer reliabilities than those obtained using the Judet-Letournel classification. This allowed us to obtain an in-depth and comprehensive understanding of QLP fractures. Additionally, the new classification might guide further studies on surgical strategies for QLP fractures. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China; Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shiwen Zhu
- Department of Orthopedics&Traumatology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Hua Chen
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, People's Republic of China
| | - Shicai Fan
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China
| | - Shuquan Guo
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chengla Yi
- Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Pararectus Approach in Acetabular Fractures in Patients Older Than 65 years. Is it Possible to Improve the Technique? J Orthop Trauma 2023; 37:109-115. [PMID: 36155367 DOI: 10.1097/bot.0000000000002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Review clinical results of the treatment for acetabular fractures using the pararectus approach and analyze surgical variations of the traditional approach. DESIGN Retrospective. SETTING Tertiary referral hospital. PATIENTS 46 patients over 65 years of age who sustained an acetabular fracture and underwent surgery using the pararectus approach. INTERVENTION Fractures were treated using a pararectus approach. Three variations of the original technique were performed: (1) Ligature of the deep iliac circumflex artery and vein, (2) separation of the psoas and iliacus muscles, and (3) isolation of the spermatic cord in men and round ligament in women together with the iliac and epigastric vessels. MAIN OUTCOME MEASUREMENTS Outcomes measures included surgical, demographic, and clinical data, and information related to follow-up. RESULTS Duration of surgery, 125 minutes (95-210). Quality of reduction on postoperative computed tomography (CT) scan; anatomic in 22 patients (47.8%), incomplete in 16 (34.8%), and poor in 8 (17.4%). In patients in whom the hip was preserved (n = 41), functional status was excellent in 15 patients (36.5%), good in 17 (41.4%), fair in 6 (14.7%), and poor in 3 (7.4%), with mean functional score of 16 points (7-18). Seven patients (15.2%) developed posttraumatic osteoarthritis and 4 of these patients underwent total hip replacement. CONCLUSIONS This study reports positive outcomes in fracture reduction and clinical outcomes with low complications in older patients who suffered acetabular fractures and were treated using a pararectus approach. Small variations in the technique, such as those proposed in this study, may help to widen access to the surgical site and simplify the technique. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Wang Z, Wang Z, Chen G, Gao M, Zhu R, Yang H. Clinical application of the anterior pelvic wall locking plate (APWLP) in acetabular fractures involving the quadrilateral surface. J Orthop Surg Res 2023; 18:76. [PMID: 36721227 PMCID: PMC9887884 DOI: 10.1186/s13018-022-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The management of acetabular quadrilateral surface fractures remains challenging for surgeons, and the treatment options for such fractures remain controversial. Quadrilateral surface surgery is a complex procedure involving combined approaches, and the quality of fracture reduction closely depends upon the surgical procedure, as well as the skill and experience of the surgeon. This study aimed to explore the clinical effects of applying an anterior pelvic wall locking plate (APWLP) through the lateral-rectus approach for treating acetabular fractures involving the quadrilateral surface. METHODS This retrospective analysis was comprised of 35 patients with acetabular fractures involving the quadrilateral surface who were treated with an APWLP in our hospital between June 2016 and December 2020. The patients included 25 males and ten females, with an average age of 52.45 years. All the patients were exposed through the lateral-rectus approach, six patients were exposed with an additional iliac fossa approach, and the fractures were fixed by combining an APWLP with a reconstruction plate. The Matta imaging standard was used to assess the quality of the fracture reduction, and the final follow-up clinical outcome was classified as excellent (18 points), good (15-17), fair (13-14), or poor (< 13) according to the modified Merle d'Aubigné-Postel scoring standard. RESULTS All patients successfully completed the operation, and there was no blood vessel or nerve injury during any of the operations. The average follow-up period was 26.11 months. The mean time of resuming full-weight-bearing activities was 12.88 weeks. Hip flexion and extension and internal and external rotation ranges of motion significantly increased over time. At the last follow-up, Matta's imaging evaluation showed that 24 cases were anatomically reduced, seven cases were satisfactory, and four cases were unsatisfactory. The satisfaction rate was 88.6% (31/35). According to the modified Merle d'Aubigné-Postel scoring standard, the hip function was excellent, good, fair, and poor in 23, 6, 4, and 2 cases, respectively. The excellent and good rates represented 82.9% of the total cases (29/35). CONCLUSION The findings suggest that the APWLP for acetabulum quadrilateral surface fracture achieve good to excellent clinical and radiological outcomes, and an APWLP may be a new treatment option for these fractures involving the quadrilateral surface.
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Affiliation(s)
- ZhiDong Wang
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - ZhenHeng Wang
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - GuangDong Chen
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - MaoFeng Gao
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - RuoFu Zhu
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - HuiLin Yang
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
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Simultaneous reduction and fixation using an anatomical suprapectineal quadrilateral surface plate through modified Stoppa approach in superomedially displaced acetabular fractures. Sci Rep 2022; 12:15221. [PMID: 36075997 PMCID: PMC9458633 DOI: 10.1038/s41598-022-19368-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Treatment of superomedially displaced acetabular fractures including a quadrilateral surface (QLS) is challenging. We present a surgical technique using an anatomical suprapectineal QLS plate through the modified Stoppa approach and report the availability of this plate to treat this fracture type along with the surgical outcomes. Sixteen consecutive patients (14 men and 2 women) who underwent surgical treatment using an anatomical suprapectineal QLS plate through a modified Stoppa approach for superomedially displaced acetabular fractures between June 2018 and June 2020, were enrolled retrospectively. These fractures included 11 both-column fractures and 5 anterior-column and posterior hemitransverse fractures, which were confirmed on preoperative 3-dimensional computed tomography. Surgical outcomes were clinically assessed using the Postel Merle d’Aubigné (PMA) score and visual analog scale (VAS) score at the final follow-up, and radiological evaluations were performed immediately after the operation and at the final follow-up. For comparative analysis, 23 patients who underwent internal fixation with the conventional reconstruction plate through modified ilioinguinal approach between February 2010 and May 2018, were selected. This control group was composed of 18 both-column fractures and 5 anterior-column and posterior hemitransverse fractures. The follow-up period was at least 1 year in all patients. The mean operation time and blood loss was 109 min, and 853 ml, respectively, whereas 236 min, and 1843 ml in control group. Anatomical reduction was achieved in 14 (87.5%) patients, while imperfect reduction was achieved in the remaining 2 patients. At the final follow-up, radiographic grades were excellent, fair, and poor in 14 patients (87.5%), one, and one, respectively. The mean PMA score was 16.1 (range 13–18) and the mean VAS score was 1.0 (range 0–3). No secondary reduction loss or implant loosening was observed. However, 2 patients underwent conversion to total hip arthroplasty (THA) due to post-traumatic arthritis and subsequent joint pain. No other complications were observed. In the comparative analysis, radiological outcome showed a significant relationship with the conversion to THA (p = 0.013). Shorter operation time and less blood loss were significantly observed in the QLS plate fixation group through the modified Stoppa approach compared with the conventional reconstruction plate fixation group through modified ilioinguinal approach (p < 0.001, respectively). Simultaneous reduction and fixation using an anatomical suprapectineal QLS plate through the modified Stoppa approach may be a viable technique in superomedially displaced acetabular fractures along with shorter operation time and less blood loss.
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Treatment of acetabular fractures with quadrilateral plate injury - a comparison of two commonly used methods. Orthop Traumatol Surg Res 2022; 108:102951. [PMID: 33932577 DOI: 10.1016/j.otsr.2021.102951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/01/2020] [Accepted: 12/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acetabular fractures with quadrilateral plate (QLP) involvement have traditionally been treated by buttress plates applied through an Ilio-inguinal approach. Recently, many surgeons prefer the application of infra-pectineal plates through the modified Stoppa approach for this purpose. Whether one method can be preferred over the other is a matter of investigation. HYPOTHESIS The research question was whether an infra pectineal plate applied through the modified Stoppa approach for acetabular fractures with QLP involvement would result in an equivalent or better outcome than a buttress plate applied through an ilioinguinal approach. PATIENTS AND METHODS This was a retrospective study of patients with QLP fractures operated by either of the two methods and who had completed at least one year follow up. Demographic and surgical details and the radiological and clinical outcomes at the last follow-up visit were obtained from patient records. RESULTS A total of 41 patients were treated with a buttress plate applied through an ilioinguinal approach (group A), and 49 patients were treated with an infra-pectineal plate by the modified Stoppa approach (group B). Duration of surgery and intra-operative blood loss was significantly less in group B patients. Radiological and clinical outcomes were better in group B patients than group A patients. Implant loosening was more frequent in group A patients. Injury to the obturator vessels were more common in group B patients. CONCLUSION With a comparatively lesser surgical duration and blood loss, better clinical and radiological outcomes at least one year after the surgery, an infra-pectineal plate applied through the modified Stoppa approach can be considered the preferred treatment for most acetabular fractures with QLP involvement. LEVEL OF EVIDENCE III.
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Outcome After Open Reduction Internal Fixation of Acetabular Fractures in the Elderly. J Orthop Trauma 2022; 36:130-136. [PMID: 34282095 DOI: 10.1097/bot.0000000000002224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES (1) Assess outcomes of acetabular open reduction and internal fixation (ORIF) in the elderly, (2) investigate factors influencing outcome, and (3) compare outcomes after low-energy and high-energy mechanisms of injury. DESIGN Retrospective case series. SETTING Level 1 trauma center. PATIENTS Seventy-eight patients older than 60 years (age: 70.1 ± 7.4; 73.1% males). INTERVENTION ORIF for acetabular fractures. MAIN OUTCOME MEASUREMENTS Complications, reoperation rates, Oxford Hip Score (OHS), and joint preservation and development of symptomatic osteoarthritis. Cases with osteoarthritis, OHS < 34, and those who required subsequent total hip arthroplasty were considered as poor outcome. RESULTS At a mean follow-up of 4.3 ± 3.7 years, 11 cases post-ORIF required a total hip arthroplasty. The 7-year joint survival post-ORIF was 80.7 ± 5.7%. Considering poor outcome as failure, the 7-year joint survival was 67.0 ± 8.9%. The grade of reduction was the most significant factor associated with outcome post-ORIF. Female sex (P = 0.03), pre-existing osteoporosis (P = 0.03), low-energy trauma (P = 0.04), and Matta grade (P = 0.002) were associated with poor outcome. Patients with associated both-column fractures were more likely to have nonanatomic reduction (P = 0.008). After low-energy trauma, joint survivorship was 36.6 ± 13.5% at 7 years compared with 75.4 ± 7.4% in the high-energy group when considering poor outcome as an end point (log rank P = 0.006). The cohort's mean OHS was 37.9 ± 9.3 (17-48). CONCLUSIONS We recommend ORIF whenever an anatomic reduction is feasible. However, achievement and maintenance of anatomic reduction are a challenge in the elderly, specifically in those with low-energy fractures involving both columns, prompting consideration for alternative management strategies. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Zhou XF, Gu SC, Zhu WB, Yang JZ, Xu L, Fang SY. Quadrilateral plate fractures of the acetabulum: Classification, approach, implant therapy and related research progress. World J Clin Cases 2022; 10:412-425. [PMID: 35097066 PMCID: PMC8771372 DOI: 10.12998/wjcc.v10.i2.412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/29/2021] [Accepted: 12/02/2021] [Indexed: 02/06/2023] Open
Abstract
The quadrilateral plate (QP) is an essential structure of the inner wall of the acetabulum, an important weight-bearing joint of the human body, which is often involved in acetabular fractures. The operative exposure, reduction and fixation of QP fractures have always been the difficulties in orthopedics due to the special morphological structure and anatomical features of the QP. Fortunately, there have been many effective methods and instruments developed for QP exposure, reduction and fixation by virtue of the combined efforts of numerous orthopedists. At the same time, each method presents with its own advantages and disadvantages, resulting in different prognoses. It is necessary to have a thorough understanding of the anatomy, radiology and fixation techniques of the QP in terms of patient prognosis optimization. In this paper, the anatomical features, definition and classification of QP, operative approach selection, implant internal fixation methods and efficacy were reviewed.
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Affiliation(s)
- Xue-Feng Zhou
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
- Graduate School, Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Si-Chao Gu
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Wan-Bo Zhu
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Jia-Zhao Yang
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Lei Xu
- Department of Traumatic Orthopedics, The First Affiliated Hospital of USTC, Hefei 230001, Anhui Province, China
| | - Shi-Yuan Fang
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
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Role of combined brim and spring plates in the treatment of acetabular fractures involving quadrilateral plates. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cha Y, Yoo JI, Kim JT, Park CH, Choy WS. How to Solve Anatomical Mismatch in Fixation of Acetabular Fractures Using an Anatomical Quadrilateral Surface Plate. Clin Orthop Surg 2022; 15:338-342. [PMID: 37008975 PMCID: PMC10060771 DOI: 10.4055/cios22169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
The anatomical quadrilateral surface buttress plate developed for the quadrilateral surface in an acetabular fracture, a type of fracture difficult to reduce using screws and plates due to its thinness, is a useful implant that makes surgical treatment easier. However, the anatomical structure is different for each patient, and it often does not match the contour of this plate, making detailed bending difficult. Here, we introduce a simple method for controlling the degree of reduction using this plate.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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Ciolli G, De Mauro D, Rovere G, Smakaj A, Marino S, Are L, El Ezzo O, Liuzza F. Anterior intrapelvic approach and suprapectineal quadrilateral surface plate for acetabular fractures with anterior involvement: a retrospective study of 34 patients. BMC Musculoskelet Disord 2021; 22:1060. [PMID: 34969392 PMCID: PMC8717694 DOI: 10.1186/s12891-021-04908-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the study is to evaluate the use of the suprapectineal quadrilateral surface (QLS) plates associated with the anterior intrapelvic approach (AIP) to the acetabulum in the surgical treatment of acetabular fractures with anterior involvement. METHODS We did a retrospective study of patients surgically treated with QLS plates and AIP for acetabular fractures with the involvement of the anterior column, between February 2018 and February 2020, in our Hospital. The following data were recorded: mechanism of injury, the pattern of fracture, presence of other associated injuries, the time before performing the surgery, surgical approach, position on operating table, time of surgery, intraoperative bleeding, hospitalization time, intraoperative and postoperative complications. Follow-ups were performed at 1, 3, 6, 12 months, then annually. The clinical-functional outcome was assessed with the Merle d'Aubigne Postel score (MAP) modified by Matta; while the radiological outcome with the Matta Radiological Scoring System (MRSS). A Chi-square test was utilized to examine associations between parametric variables. RESULTS We included 34 patients, mean age 62.1, with an average follow-up of 20.7 months. The most frequent traumatic mechanism was road trauma. There were 15 isolated anterior columns and 19 associated patterns. There were 5 cases of associated visceral injuries, and 10 cases of other associated skeletal fractures. All patients were in the supine position. The surgical approach used was the AIP in all cases, with the addition of the first window of the ilioinguinal approach in 16 cases and of the Kocher-Langenbeck approach in 2 cases. The average time before performing the surgery was 8.5 days. The mean time of the surgery and the mean length of stay after surgery were 227.9 min and 8.2 days, respectively. There weren't cases of intra-operative complications, while there were postoperative complications in 5 patients. The MRSS was judged anatomical in 26 cases, imperfect in 7 cases and poor in 1 case. The average MAP value was 15.2. We observed a significant relationship between the radiological outcome and the clinical outcome (p < 0.05). CONCLUSIONS The QLS plates in association with the AIP approach represent an effective treatment strategy for the treatment of acetabular fractures with anterior involvement.
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Affiliation(s)
- Gianluca Ciolli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico De Mauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Marino
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Are
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Omar El Ezzo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
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Küper MA, Ateschrang A, Hirt B, Stöckle U, Stuby FM, Trulson A. Laparoscopic Acetabular Surgery (LASY) - vision or illusion? Orthop Traumatol Surg Res 2021; 107:102964. [PMID: 34033917 DOI: 10.1016/j.otsr.2021.102964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/02/2020] [Accepted: 01/13/2021] [Indexed: 02/03/2023]
Abstract
Displaced acetabular fractures usually require open surgical approaches. Aim of this cadaver study was to evaluate a laparoscopic approach to prepare the anterior acetabular column and the quadrilateral plate in analogy to the laparoscopic pelvic lymphadenectomy. The laparoscopic preparation and anatomy is presented and illustrated step by step in a human cadaver followed by a modular plate osteosynthesis of the anterior column involving the quadrilateral plate is performed via a minimally invasive approach using standard laparoscopic instruments. In conclusion we could demonstrate that the laparoscopic preperitoneal preparation of the acetabulum according to the laparoscopic pelvic lymphadenectomy provides more free range for the surgical instruments compared to a previously described total extraperitoneal approach. The development of specific reduction tools and implants is under investigation. Until then, at least the laparoscopic preparation could be introduced in the clinical setting in the near future. TYPE OF STUDY: Technical note - Cadaver study.
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Affiliation(s)
- Markus Alexander Küper
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany.
| | - Atesch Ateschrang
- Ev. Stift St. Martin, Department for Orthopedics and Traumatology, Koblenz, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, Eberhard Karls University, Tübingen, Germany
| | - Ulrich Stöckle
- Charité University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Fabian Maria Stuby
- BG Trauma Center, Department for Traumatology, Orthopedics and Surgery, Murnau am Staffelsee, Germany
| | - Alexander Trulson
- BG Trauma Center, Department for Traumatology, Orthopedics and Surgery, Murnau am Staffelsee, Germany
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Acetabular Fractures with Central Hip Dislocation: A Retrospective Consecutive 50 Case Series Study Based on AO/OTA 2018 Classification in Midterm Follow-Up. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6659640. [PMID: 34568493 PMCID: PMC8463190 DOI: 10.1155/2021/6659640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
Introduction Management of acetabular fractures is challenging, especially when a medial acetabular fracture is complicated by central hip dislocation. We retrospectively investigated the clinical outcome and risk factors of secondary hip osteoarthritis requiring total hip arthroplasty after the surgical treatment of acetabular fractures with central hip dislocation. Materials and Methods The medical records of all patients who had acetabular medial wall fractures with central hip dislocation treated with open reduction and internal fixation by a single surgeon between January 2015 and June 2017 were reviewed. Surgical reduction was performed with the modified Stoppa with/without the Kocher-Langenbeck (KL) approach. Patients were followed for a minimum of three years, and the Majeed scoring system was used for functional evaluation. Multivariate logistic regression analysis was used to assess the association of patients' characteristics with the likelihood of advanced posttraumatic arthritis developing with conversion to total hip arthroplasty. Results Fifty patients were included in this study, with disease classified as AO/OTA 2018 62B/62C. Thirty-five patients (70%) had good or excellent Majeed pelvic scores. Eleven patients (22%) eventually received total hip arthroplasty because of end-stage posttraumatic arthritis. Three risk factors identified for total hip arthroplasty were male sex, initial marginal impaction, and sciatic nerve injury. Kaplan-Meier survivorship analysis estimated that the cumulative probability of free-from-end-stage arthritis was 78% (95% confidence interval, 73%–90%) at the 5-year follow-up. Conclusion Surgical fixation with the modified Stoppa and the KL approach for acetabular medial wall fractures with central hip dislocation is an effective approach with a satisfactory functional outcome. A prodromal factor was marginal impaction concomitant with articular damage. The trauma of high axial loading and the occupational distribution (males performing heavy manual labor and heavy lifting) with preoperative sciatic nerve injury increased the odds of developing end-stage arthritis.
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Surgical Drill Guide for Insertion of an Infra-Acetabular Screw Based on an Anatomically Precontoured Plate System: A Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2321504. [PMID: 34355040 PMCID: PMC8331300 DOI: 10.1155/2021/2321504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/03/2021] [Indexed: 11/18/2022]
Abstract
Purpose Due to the anatomic structure of the pelvis, free-hand placement of screws in the acetabular fracture management can be difficult. Infra-acetabular screw fixation increases acetabular stability by distal fixation of the cup. Aim of this cadaveric study is to investigate if a plate-referenced drill guide can provide save placement of an infra-acetabular screw over a precontoured suprapectineal quadrilateral buttress plate (SQBP). Methods We constructed a drill guide for an infra-acetabular screw based on the surface of an anatomically precontoured SQBP. A total of 12 adult cadaveric acetabular specimens were used for drill guide-assisted placement of the infra-acetabular screw. The drill guide contains a radiopaque spiral to allow longitudinal fine adjustment of the SQBP along the pelvic brim to assure correct position of the plate-drill-guide construct in relation to the Koehler's teardrop. After screw placement, we conducted a computed tomography (CT) scan of all specimens to assess the actual position of the screw in relation of the infra-acetabular corridor and the acetabular joint surface. Results The position of the screw was within the infra-acetabular corridor in all cases. We did not see any intra-articular or intrapelvic screw penetration. The mean distance of the centerline of the screw to the medial border of the infra-acetabular corridor was 3.35 mm. The secure distance to the virtual surface of the femoral head to was 7.3 mm. Conclusions A plate-referenced drill guide can provide safe placement of an infra-acetabular screw for treatment of acetabular fractures. Radiographic fine adjustment is necessary to access the optimal entry point.
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Zhao B, Zhang W, Li H, Han L, Han S, Yang X, Yan J, Mu W. The largest secure corridor of the infra-acetabular screw-a 3-D axial perspective analysis. BMC Musculoskelet Disord 2021; 22:551. [PMID: 34134690 PMCID: PMC8210356 DOI: 10.1186/s12891-021-04433-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background The infra-acetabular screw which is placed from the pubis to the ischium can be used as a special positional screw of the posterior column of the acetabulum. This study was performed to simulate the surgical procedure and obtain the ideal insertion point, diameter, length and angle of the screw through the method of axial perspective in Chinese patients. Methods We randomly collected the pelvic computed tomography (CT) scans of 200 adults. DICOM-formatted CT-scan images were imported into Mimics software to establish the 3D digital model of the right semi-pelvic was established. A virtual cylinder representing the screw was placed from the pubis to the ischium to fix the posterior column. The largest secure diameter and length of the virtual screw were measured and the position of the insertion point and the directions of the screw were also researched. Results The screw insertion safe zone exhibits an irregular shape of “tear drop” in the reconstructed pelvic model. The mean maximum diameter of screws was 5.01 ± 1.28 mm, and the mean maximum length of screws was 93.99 ± 8.92 mm. The screw insertion corridor with the least diameter 3.5 mm was found in 94 of 100 males (94%) and 86 of 100 females (86%). We found gender-dependent differences for the mean maximum diameter and the maximum length of the screw. There was statistically significant difference between genders in the position of insertion point. Conclusions In this study, we suggest an individual preoperative 3D reconstruction simulation to develop better screw placement plans, which provides a valuable guideline for seeking the largest secure corridor of infra-acetabular screw. Further biomechanical studies are needed to verify the function of the screw.
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Affiliation(s)
- Bei Zhao
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China.,Department of Traumatic Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wei Zhang
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Hao Li
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Liren Han
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Shizhang Han
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Xiaofei Yang
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Jun Yan
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China.
| | - Weidong Mu
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Panella A, Solarino G, Vicenti G, Bizzoca D, Baglioni M, Fortunato F, Maruccia F, Notarnicola A, Piazzolla A, Pascarella R, Belluati A, Moretti B. Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery? Aging Clin Exp Res 2021; 33:1627-1633. [PMID: 32902823 PMCID: PMC8203512 DOI: 10.1007/s40520-020-01682-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
Background Osteoporotic acetabular fractures frequently involve the quadrilateral plate (QP), a flat and thin bone constituting the medial wall of the acetabulum. This study aims to assess the impact of the quality of osteoporotic QP fractures reduction on the patients’ functional recovery, at 24 months follow-up. Methods Patients referring with osteoporotic QP fractures to our Level I trauma centre were prospectively recruited. Inclusion criteria: patients aged 60 years old or older; osteoporosis, defined as Dual-energy X-ray Absorptiometry (DXA) T-score ≤ − 2.5; acute acetabular fracture; anatomic or good fracture reduction according to Matta on postoperative CT. Exclusion criteria: moderate cognitive impairment (defined as Mini-Mental State Examination < 19); a history of malignant neoplasm; concomitant fractures in other sites; traumatic head injury; lower limb joint prostheses; patient not able to walk independently before trauma; poor fracture reduction, according to Matta, on postoperative CT. All the QP fractures were surgically managed. After surgery, the reduction of each QP fracture was classified as anatomical (displacement 0–1 mm), good (displacement 2–3 mm) and poor (displacement > 3 mm) on postoperative CT. Based on this classification: patients with a poor fracture reduction were excluded from this study, patients with an anatomical reduction were recruited in Group-A and patients with a good reduction in Group-B. All the patients underwent a clinical and radiographic 24-months follow-up. Results 68 patients (males 38; females 30; mean age 68.6 years old; range 60–79) were finally included in in the study. No cases of open fractures or concomitant pelvic ring fractures were observed. Based on the post-operative CT, 39 patients showed an anatomic fracture reduction (Group-A) while the remaining 29 patients revealed a good fracture reduction (Group-B). Complication rates and mean clinical scores showed no significant differences between groups, at 24-months follow-up. Conclusions In this study, the functional recovery at 24 months follow-up showed no significant differences in elderly patients with QP fracture undergoing anatomical reconstruction (displacement 0–1 mm) compared to patients receiving a good QP fracture reconstruction (displacement ≤ 3 mm).
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Affiliation(s)
- Antonello Panella
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Giovanni Vicenti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Davide Bizzoca
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Marco Baglioni
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Francesco Fortunato
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Francesco Maruccia
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Angela Notarnicola
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Andrea Piazzolla
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Raffaele Pascarella
- Department of Orthopaedic and Trauma Surgery, Ospedali Riuniti, Ancona, Italy
| | | | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
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Nadeem U, Qadir I, Mazari J, Zaman AU, Aziz A. Outcomes of Direct Infrapectineal Buttress Plate for Quadrilateral Surface Fractures of Acetabulum Using an Anterior Intrapelvic Approach. Hip Pelvis 2021; 33:33-39. [PMID: 33748024 PMCID: PMC7952272 DOI: 10.5371/hp.2021.33.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Reduction and stable fixation of the quadrilateral plate are challenging primarily due to its location in the true pelvis, limited bone stock, juxta-articular nature, and its comminution. The current study aimed to investigate the quality of reduction and functional outcomes after open reduction and internal fixation (ORIF) with infrapectineal buttress plating of the quadrilateral surface via an anterior intrapelvic approach. Materials and Methods We conducted a retrospective review of twenty-one patients with acetabular fractures involving quadrilateral plate operated at Ghurki Trust Teaching Hospital between January 2017 and December 2018. Radiological assessment of the quality of reduction was conducted using criteria described by Matta. Functional outcomes were evaluated using a modified Postel Merle d'Aubigné score. Results The current study included 15 males and 6 females with a mean age of 40.67±12.17 years (range, 22–62 years). The most common fracture pattern was anterior column and posterior hemi-transverse in eight patients followed by true bicolumn and T-type fractures in seven and four patients respectively. Both transverse fractures were transtectal. The quality of reduction according to Matta criteria was anatomical in 14 patients, imperfect in five and poor in two. Functional outcomes were excellent in 47.6% cases, good in 42.9%, and fair in 9.5% cases. Both patients with fair outcomes had non-anatomical reduction, and one required total hip arthroplasty at a later time. Conclusion Quadrilateral plate reconstruction with an infrapectineal buttress plate applied though an anterior intrapelvic approach provides high rates of anatomical reduction and yields good functional outcomes.
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Affiliation(s)
- Umair Nadeem
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Irfan Qadir
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Jahanzeb Mazari
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Atiq Uz Zaman
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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Verma S, Agrawal A, Choudhary R, Venishetty N. Management of quadrilateral plate fractures: An up to date. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_26_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rommens PM, Herteleer M, Handrich K, Boudissa M, Wagner D, Hopf JC. Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures. PLoS One 2020; 15:e0243592. [PMID: 33284841 PMCID: PMC7721143 DOI: 10.1371/journal.pone.0243592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background In geriatric acetabular fractures, the quadrilateral plate is often involved in the fracture pattern and medially displaced. Open reduction and internal fixation (ORIF) includes reduction of the quadrilateral plate and securing its position. In this study, the concept of medial buttressing in acute and periprosthetic acetabular fractures is evaluated. Materials and methods Patients, who sustained an acetabular fracture between 2012 and 2018, in whom ORIF with a specific implant for medial buttressing was performed, were included in the study. Patients were divided in two groups; acute acetabular fractures (group 1) and periprosthetic acetabular fractures (group 2). Demographics, type of fracture, surgical approach, type of implant for medial buttressing, comorbidities, general and surgical in-hospital complications and length of hospital stay were recorded retrospectively. The following data were collected from the surviving patients by telephone interview: EQ-5D-5L, SF-8 physical and SF-8 mental before trauma and at follow-up, UCLA activity scale, Parker Mobility Score and Numeric Rating Scale. Results Forty-six patients were included in this study, 30 males (65.2%) and 16 females (34.8%). Forty patients were included group 1 and six patients in group 2. The median age of patients of group 1 was 78 years. Among them, 82.5% presented with comorbidities. Their median length of in-hospital stay was 20.5 days. 57.5% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all but one patient. ORIF together with primary total hip arthroplasty (THA) was carried out as a single stage procedure in 3 patients. Secondary THA was performed in 5 additional patients (5/37 = 13.5%) within the observation period. Among surviving patients, 79.2% were evaluated after 3 years of follow-up. Quality of life, activity level and mobility dropped importantly and were lower than the values of a German reference population. SF-8 mental did not change. The median age of patients of group 2 was 79.5 years, all of them presented with one or several comorbidities. The median length of in-hospital stay was 18.5 days. 50% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all patients. 5 of 6 patients (83.3%) could be evaluated after a median of 136 weeks. In none of these patients, secondary surgery was necessary. Quality of life, activity level and mobility importantly dropped as well in this group. SF-8 mental remained unchanged. Conclusion In geriatric acetabular fractures with involvement and medial displacement of the quadrilateral plate, medial buttressing as part of ORIF proved to be reliable. Only 13.5% of patients of group 1 needed a secondary THA within 3 years of follow-up, which is lower than in comparable studies. Despite successful surgery, quality of life, activity level and mobility dropped importantly in all patients. The loss of independence did however not influence SF-8 mental values.
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Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- * E-mail:
| | - Michiel Herteleer
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kristin Handrich
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Johannes Christof Hopf
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
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Pohlemann T, Herath SC, Braun BJ, Rollmann MF, Histing T, Pizanis A. Anterior approaches to the acetabulum: which one to choose? EFORT Open Rev 2020; 5:707-712. [PMID: 33204514 PMCID: PMC7608571 DOI: 10.1302/2058-5241.5.190061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Surgical treatment of acetabular fractures remains challenging even for experienced surgeons. Whilst the ilioinguinal and the Kocher-Langenbeck approach remain the standard procedures to expose the anterior or posterior aspects of the acetabulum, some modified anterior approaches for the stabilization of the acetabulum have been introduced. This article will provide an overview of approaches to the anterior aspect of the acetabulum and explain the efforts that have been made to improve the surgeon’s options for certain fracture modifications, such as fractures with separation of the quadrilateral surface. Cite this article: EFORT Open Rev 2020;5:707-712. DOI: 10.1302/2058-5241.5.190061
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Affiliation(s)
- Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Steven C Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Mika F Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Tina Histing
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Antonius Pizanis
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
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Sen RK, Saini G, Kadam S, Raman N. Anatomical quadrilateral plate for acetabulum fractures involving quadrilateral surface: A review. J Clin Orthop Trauma 2020; 11:1072-1081. [PMID: 33192011 PMCID: PMC7656483 DOI: 10.1016/j.jcot.2020.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The management of acetabulum fractures in osteoporotic elderly, as well as comminuted fractures in younger patients is likely to be difficult. These fractures need specific fixation techniques especially when the quadrilateral plate is involved. Standard implants may not be able to adequately support the fixation, so newer pre-shaped fixation plates have been proposed with some of these already in use. The concept of anatomic plates has come up for many fracture locations for providing a better buttress effect to the comminuted fragments. There has been a need to look for an anatomic buttress plates being developed for acetabulum fractures involving the quadrilateral surface. MATERIALS AND METHODS The literature has been reviewed to find the various newer designs that have been used for buttressing the quadrilateral surface in comminuted acetabular fractures. An attempt has been made to study their design characteristics and clinical outcomes. The review also includes the analysis of Anatomic Quadrilateral plate (AQP) used in fixation of acetabulum fracture involving quadrilateral surface in a series of 33 patients. RESULTS There has been few anatomical plates developed for the stabilization of acetabular quadrilateral surface fractures. Some of these plates have been successfully used in management of acetabular fractures primarily in young patients. Issues however remain in their application and outcomes in osteoporotic fractures of the acetabulum, as these plates support the pelvic brim fragments either from superior or medial surface. The newer development i.e. 'Anatomical Quadrilateral Plate' is optimized to counter the displacement forces due to its positioning on the pelvic brim rather than its superior or medial surface. Other special features include the possibility of longer screws across bone due to oblique position of holes, the typical location of a locking hole on the plate beam which permits dual cortical compression fixation either by using a bigger screw or a specially designed screw in screw construct across the supra-acetabular corridor. The option of using hybrid fixation of both locking and unlocked screws in AQP allows proper stress distribution on the underlying bone, aiding both primary as well as secondary stability. The minimum of one year post surgery outcome of patients having acetabular fixation using this Anatomic quadrilateral plate has been analyzed in 33 patients. Twenty three of these were aged more than 50 years and 28 out of total 33 were males. Associated injuries included Ipsilateral lower limb injury in 2 patients and distal radius fracture in 5 patients. The fracture pattern included 'Anterior column posterior hemi-transverse' in 10 patients,' Associated Both Column' injury in 9 and 'T type' acetabular fractures in 8 patients. Isolated 'Anterior column' was fractured in 6 patients. The surgical approach was 'Anterior Intra-pelvic' (AIP) in 23 patients and 'Modified Ileo-femoral' in other 10 patients. One patient had additional K L approach. Among the implants, the AQP plate was used without its pubic arm in 6 patients. The post-operative x rays showed anatomical reduction in 28 patients, while other 5 had gaps and/or steps up to 2 mm size. In subsequent car, one of these patients needed hip arthroplasty for problem arising due to collapse in fixation within six months. EQ 5D 5L telephonic score was used to know the outcome at minimum of one year follow up in 33 patients. As per this score, only 3 patients had an issue with mobility, with only one having problem in self-care activity. Six patients complained of minor limitations in carrying out their usual activities and only one patient had anxiety affecting him. In their self-assessment of overall health status, 22 patients marked it 100, 7 made it 90, 3 as 80 and 1 had marked it as 70 in a score range of 0-100. Considering the predominant elderly profile in this series of patients, the acetabular reconstruction using 'Anatomic quadrilateral plate' has shown encouraging results. CONCLUSION For stabilization of acetabular fractures involving quadrilateral surface area and pelvic brim, various new implants have been used. The Anatomic quadrilateral plate due to its anatomical shape, the various options in fracture fixation is best optimized for management of comminuted acetabulum fractures especially in poor quality bones. It has been successful in achieving good outcome in elderly group of patients having these complex injuries.
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Affiliation(s)
- Ramesh K. Sen
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Gaurav Saini
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Sagar Kadam
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Neha Raman
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
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Nicol G, Sanders E, Liew A, Wilkin G, Gofton WT, Papp S, Grammatopoulos G. Does use of a quadrilateral surface plate improve outcome in elderly acetabular fractures? J Clin Orthop Trauma 2020; 11:1045-1052. [PMID: 33192008 PMCID: PMC7656488 DOI: 10.1016/j.jcot.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/22/2020] [Accepted: 10/02/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Acetabular fractures in the elderly frequently involve segmental quadrilateral plate injury, yet no consensus exists on how to best control the femoral head medial displacement. Quadrilateral surface plates (QSP) were developed to help buttress these challenging fractures. The study aims to 1) Determine the prevalence of segmental quadrilateral plate fractures (SQPF) in elderly patients; and 2) Assess if utilization of a QSP is associated with improved acetabulum fracture reduction and outcome. METHODS This was a retrospective study conducted at a level-1 trauma centre. . All patients over 60-years that sustained an acetabular fracture between 2007 and 2019 were reviewed. Pre-operative pelvic radiographs and CT imaging were reviewed for 96 patients, to assess for SQPF. From the 96 patients reviewed, over one third of patients (n = 40, 41.6%) sustained a SQPF. Patients that had an acute-THA (n = 7) were excluded as were patients that underwent an ORIF but did not have a QSP or an anterior column buttress plate (n = 3). The remaining 30 formed the study's cohort. We assessed the ability to achieve and maintain reduction in this elderly population, and compared outcomes using traditional anterior column buttress plates (ilioingual or intra-pelvic approach) versus an intra-pelvic pre-contoured buttress suprapectineal plate (QSP). Outcome measures included: fracture reduction using the Matta classification (desirable: anatomical/imperfect and poor), re-operations, conversion to THA and Oxford Hip Score (OHS) (for the preserved hips). RESULTS Ten patients had an ORIF with utilization of a QSP (QSP-group), and 20 had an ORIF but did not have the QSP (non-QSP-group). There was no difference in patient demographics between groups. Fracture patterns were also similar (p = 0.6). Postoperative fracture reduction was desirable (anatomical/imperfect) in 17 patients and poor in 13. Improved ability to achieve a desirable reduction was seen in the QSP-group (p = 0.02). Conversion to THA was significantly lower in patients that had a desirable fracture reduction (appropriate: 3/17; poor: 7/13). No patients in the QSP-group have required a THA to-date, compared to 10/20 patients in the non-QSP-group (p = 0.01). The mean time to THA was 1.6 ± 2.1 year. There was no difference in OHS between the two groups (34.4 ± 10.3). CONCLUSION Elderly acetabulum fractures have a high incidence (approaching 40%) of segmental QPF. Desirable (anatomical/imperfect) fracture reduction was associated with improved outcome. The use of a QSP was associated with improved ability to achieve an appropriate reduction. A QSP should be considered as they are both reliable and reproducible with a significantly improved fracture reduction and lower conversion to THA.
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Affiliation(s)
- Graeme Nicol
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ethan Sanders
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Allan Liew
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Geoffrey Wilkin
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wade T. Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Steven Papp
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Fractures of the acetabulum: from yesterday to tomorrow. INTERNATIONAL ORTHOPAEDICS 2020; 45:1057-1064. [PMID: 32964295 PMCID: PMC8052228 DOI: 10.1007/s00264-020-04806-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022]
Abstract
Purpose The aim of this article is to present history, state of the art, and future trends in the treatment of acetabular fractures. Methods Review of recent and historical literature. Results Acetabular fractures are difficult to treat. The first descriptions of this injury already appeared in ancient Greek history, but intensive development started in the second half of the twentieth century after Judet and Letournel’s seminal work. Their classification is still the gold standard today. It is actually a pre-operative planning system and is used to determine the most appropriate surgical approach. The therapy of choice for dislocated fractures is open reduction and internal fixation. Recent modern techniques based on high-tech computerized planning systems and 3D printing have been successfully integrated into orthopaedic trauma practice. Conclusion There is no ideal surgical approach for acetabulum fracture treatment, so new approaches have been developed in recent decades. The best outcome series have shown good or excellent results, between 70 and 80%.
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Zha GC, Tulumuhan DM, Wang T, Wan GY, Wang Y, Sun JY. A new internal fixation technique for acetabular fractures involving the quadrilateral plate. Orthop Traumatol Surg Res 2020; 106:855-861. [PMID: 31862320 DOI: 10.1016/j.otsr.2019.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The treatment of acetabular fracture involving the quadrilateral plate is a technical challenge, and the optimal management of the fracture remains controversial. We have designed a new implant (named acetabular fracture reduction internal fixator, AFRIF) for acetabular fractures involving the quadrilateral plate. This use of this new device was not investigated therefore we conducted a retrospective study aiming to determine whether the AFRIF can achieve satisfactory clinical and radiological outcomes for quadrilateral plate fracture. HYPOTHESIS The AFRIF for quadrilateral plate fracture is an acceptable option to treat acetabular fracture involving the quadrilateral plate. MATERIALS AND METHODS We performed a retrospective analysis of prospectively collected data on 24 patients (15 males and 9 females) with acute displaced quadrilateral plate fractures of the acetabulum who were treated by the AFRIF between August 2011 and May 2015. The mean age of the patients was 61.5±9.2 years (range, 31-82 years). All hips had protrusion of the femoral head, of these 5 hips with associated articular impaction of the medial roof. The type of fractures included anterior column in 4, anterior column+posterior hemitransverse in 3, associated both column in 11, T-shaped in 6 patients. The approaches included Limited Ilioinguinal (5 patients) and Limited Standard-Ilioinguinal combined with Kocher-Langenbeck (19 patients). Quality of reduction was evaluated and graded as anatomical (0mm to 1mm of displacement), imperfect (2mm to 3mm displacement) or poor (more than 3mm displacement) according to the residual displacement as defined by Matta. The final follow-up clinical outcome was classified as excellent (18 points), good (15-17 points), fair (13-14 points) or poor (<13 points) in terms to the modified Merle d'Aubigné-Postel score, and radiological outcomes evaluation were as excellent, good, fair, or poor based on Matta score. RESULTS The mean duration of follow-up was 45.7±13.0 months (range, 24-60 months). Average operative time and bleeding amount was 110.3±30.8min (range, 105-210min) and 950.6±348.6ml (range, 300-1500ml), respectively. There was anatomical reduction in 17 patients (17/24, 70.8%), imperfect in 5 patients (5/24, 20.8%), and poor in 2 patients (2/24, 8.3%). All of the quadrilateral plate fractures achieved anatomical except one imperfect reduction. No re-protrusion of the femoral head was observed at the final follow-up. The mean modified Merle d'Aubigné-Postel score was 16.9±2.0 points (range, 10-18 points), and 83.3% (20 of 24) have good or excellent radiological outcomes. DISCUSSION The findings suggest that the AFRIF for quadrilateral plate fractures may prevent protrusion of the femoral head and achieve good to excellent clinical and radiological outcomes. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Guo-Chun Zha
- Department of Orthopedic Surgery, the Affiliated Hospital of Xuzhou Medical University, No. 99, Huaihai West Road, 221002 Xuzhou, Jiangsu, P.R. China.
| | - Du-Man Tulumuhan
- Department of Orthopedic Surgery, Kuitun Hospital of Yi Li Kazak Autonomous Prefecture, No. 32, Tacheng Street, 833200 Yi Li Kazak Autonomous Prefecture, Xinjiang Uygur Autonomous Region, P.R. China
| | - Tao Wang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Ruijin 2nd Road, 200025 Shanghai, P. R. China
| | - Guo-Yang Wan
- Department of Orthopedic Surgery, the Affiliated Suzhou hospital of Nanjing Medical University, 242, Guangji Road, 215006 Suzhou, Jiangsu, P.R. China
| | - Yong Wang
- Department of Orthopedic Surgery, Yixing People's Hospital, 75, Tong zhen Road, 214200 Yi xing, Jiangsu, P.R. China
| | - Jun-Ying Sun
- Orthopaedic Department, the First Affiliated Hospital of Soochow University, 188, Shizi Street, 215006 Suzhou, Jiangsu, P.R. China
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Wu HY, Shao QP, Song CJ, Shang RR, Liu XM, Cai XH. Personalized Three-Dimensional Printed Anterior Titanium Plate to Treat Double-Column Acetabular Fractures: A Retrospective Case-Control Study. Orthop Surg 2020; 12:1212-1222. [PMID: 32725701 PMCID: PMC7454211 DOI: 10.1111/os.12741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
Objective To compare the clinical efficacy and safety of a personalized three‐dimensional (3D) printed dynamic anterior plate–screw system for the quadrilateral area (DAPSQ) titanium plate and a traditional DAPSQ reconstruction plate in the treatment of double‐column acetabular fractures. Methods This was a retrospective case‐control study. From May 2014 to January 2018, 43 patients with double‐column acetabular fractures underwent open reduction and internal fixation. Among these, 20 cases were fixed with a 3D printed DAPSQ plate (3D printed group) and 23 cases were fixed with a DAPSQ reconstruction plate (control group). The 3D printed group comprised 15 men and 5 women, with an average age of 50.1 ± 8.2 years. The control group comprised 16 men and 7 women, with an average age of 51.0 ± 8.6 years. The evaluation index included the surgical data (i.e. blood loss, operating time, duration of hospital stay, and intraoperative and postoperative complications), position and length of implants, reduction quality, hip function, and related complications. The reduction quality was evaluated using the Matta scoring standard and hip function was evaluated using the modified Merle d’Aubigné score. Results A total of 43 patients met the inclusion criteria. The mean postoperative follow up was 35.2 months in the 3D printed group and 36.9 months in the control group. There were no significant group differences in demographic data between the two groups. The position and length of the 3D printed implants were generally in accord with preoperative planning using a 3D pelvic model. Patients in the 3D printed group had significantly shorter operation time (223.2 vs 260.5 min, P < 0.05) and less intraoperative blood loss (930.4 vs 1426.1 mL, P < 0.05) compared to the control group. Anatomic, imperfect, and poor reduction was obtained in 13, 5, and 2 cases in the 3D printed group, respectively, and was obtained in 12, 8, and 3 cases in the control group. The modified Merle d’Aubigné scores were excellent in 11 cases, good in seven cases, and fair in two cases in the 3D printed group. They were excellent in 11 cases, good in eight cases, fair in three cases, and poor in one case in the control group. The reduction quality and hip function did not differ within the groups (P > 0.05). The general complication rate in the 3D printed group and the control group was 15% and 26.1%, respectively, but the difference between the two groups was not statistically significant. Conclusion Use of a personalized 3D printed DAPSQ plate has potential advantages in reducing the operation time and blood loss during the treatment of double‐column acetabular fractures.
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Affiliation(s)
- Hai-Yang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Qi-Peng Shao
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Cheng-Jing Song
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Ran-Ran Shang
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Xi-Ming Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Xian-Hua Cai
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
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Wang C, Chen Y, Wang L, Wang D, Gu C, Lin X, Liu H, Chen J, Wen X, Liu Y, Huang F, Yao L, Fan S, Huang W, Dong J. Three-dimensional printing of patient-specific plates for the treatment of acetabular fractures involving quadrilateral plate disruption. BMC Musculoskelet Disord 2020; 21:451. [PMID: 32650750 PMCID: PMC7350601 DOI: 10.1186/s12891-020-03370-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/27/2020] [Indexed: 01/21/2023] Open
Abstract
Background Complicated acetabular fractures comprise the most challenging field for orthopedists. The purpose of this study was to develop three-dimensional printed patient-specific (3DPPS) Ti-6Al-4 V plates to treat complicated acetabular fractures involving quadrilateral plate (QLP) disruption and to evaluate their efficacy. Methods Fifty patients with acetabular fractures involving QLP disruption were selected between January 2016 and June 2017. Patients were divided into a control group (Group A, 35 patients) and an experimental group (Group B, 15 patients), and were treated by the conventional method of shaping reconstruction plates or with 3DPPS Ti-6AL-4 V plates, respectively. The efficacy of Ti-6AL-4 V plates was evaluated by blood loss, operative time, reduction quality, postoperative residual displacement, and complications. Results The operative time and blood loss in Group B were reduced compared to Group A, and the difference was statistically significant (P < 0.05). There was no significant difference in reduction quality between the two groups (P > 0.05). Reduction quality in Group B was anatomic in 10 (66.7%), satisfactory in four (26.7%), and poor in one (6.7%). In Group A, they were anatomic in 18 (51.4%), satisfactory in 13 (37.1%), and poor in four (11.4%). Residual displacement in Group B was less than that in Group A, and the difference was statistically significant (P < 0.05). In Group B, one case exhibited loosening of the pubic screw postoperatively. In Group A, there was one case of wound infection, one of deep vein thrombosis (DVT) in the ipsilateral lower limb, one case of traumatic arthritis and two obturator nerve injuries. Conclusions The 3DPPS Ti-6AL-4 V plate is a feasible, accurate and effective implant for acetabular fracture treatment.
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Affiliation(s)
- Canbin Wang
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China.,The First People's Hospital of Foshan, Foshan, 528200, China
| | - Yuhui Chen
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Liping Wang
- Department of Hand Surgery, and Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China.,UniSA Clinical & Health Sciences, and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia
| | - Di Wang
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Cheng Gu
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Xuezhi Lin
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Han Liu
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Jiahui Chen
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Xiangyuan Wen
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Yuancheng Liu
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Fuming Huang
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Lufeng Yao
- Department of Hand Surgery, and Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China
| | - Shicai Fan
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China.
| | - Wenhua Huang
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China. .,School of Basic Medical Sciences, Southern Medical University, No.1023 - No.1063 Shatai South Road, Guangzhou, 510515, Guangdong, China.
| | - Jianghui Dong
- Department of Hand Surgery, and Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China. .,UniSA Clinical & Health Sciences, and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.
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Zhao B, Sun Z, Zhang W, Xu Z, Yang X, Mu W. Digital anatomical study and clinical application of screw placement for quadrilateral plate fractures in the danger zone. BMC Musculoskelet Disord 2020; 21:222. [PMID: 32278348 PMCID: PMC7149894 DOI: 10.1186/s12891-020-03265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Direct screw placement for quadrilateral plate fractures in the danger zone of the acetabulum is very difficult. This study was performed to simulate the surgical procedure and try to obtain effective and safe screw angles through the middle window of the ilioinguinal approach in Chinese patients. METHODS We randomly collected the pelvic computed tomography (CT) scans of 100 adults. DICOM-formatted CT-scan images were imported into Mimics software. The three-dimensional reconstruction (3D) digital model of the semi-pelvis was established. A 3.5 mm cylinder was used to simulate the pathway of the screw from the designated insertion point. The angles of insertion and intersex differences were explored by statistical analyses. RESULTS The screws could be inserted via three angles: medial inclination, anterior inclination and posterior inclination. The mean minimum medial inclination angle (MIMIA) of insertion point A was 4.96° ± 1.11° in males and 8.66° ± 3.40° in females, and the intersex difference was significant. The mean minimum medial inclination angle (MIMIA) of insertion point B was - 5.31° ± 3.69° in males and 1.75° ± 8.95° in females, and the intersex difference was significant. There were no differences between any of the angles for males and females at insertion point O. CONCLUSIONS Preoperative measurement and calculation by digital tools before screw placement for quadrilateral plate fractures of the acetabulum are feasible. Double cortical screws could be placed safely in the danger zone through the middle window of the ilioinguinal approach to increase the stability of the acetabulum.
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Affiliation(s)
- Bei Zhao
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250012 Shandong China
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Zhongye Sun
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Wei Zhang
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Zhongbao Xu
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Xiaofei Yang
- Department of Orthopaedics, Liaocheng People’s Hospital, Liaocheng, Shandong China
| | - Weidong Mu
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250012 Shandong China
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Wu H, Shang R, Cai X, Liu X, Song C, Chen Y. Single Ilioinguinal Approach to Treat Complex Acetabular Fractures with Quadrilateral Plate Involvement: Outcomes Using a Novel Dynamic Anterior Plate-Screw System. Orthop Surg 2020; 12:488-497. [PMID: 32162455 PMCID: PMC7189029 DOI: 10.1111/os.12648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives To evaluate the efficacy and safety of a novel fixation technique referred to as the dynamic anterior plate–screw system for quadrilateral plate (DAPSQ) for complex acetabular fractures with quadrilateral plate involvement through the single ilioinguinal approach. Methods A total of 32 patients with acetabular fractures, selected between January 2009 and March 2016, were managed by DAPSQ with “quadrilateral screws” through single ilioinguinal approach. The primary outcomes measure was the reduction quality evaluated according to the Matta radiological criteria, and the functional outcomes were evaluated by the modified Merle d'Aubigné score at the last follow‐up. Secondary outcomes were postoperative complications and intraoperative conditions included, for instance, operation time and blood loss. Results Of these 32 consecutive patients, 19, 9, and 4 were classified as both columns, anterior column posterior hemi‐transverse, and T‐shaped fractures, respectively, and with an average of 47 months’ follow‐up. Anatomic reduction was obtained in 19 cases (59%), imperfect reduction in 9 cases (28%), and poor reduction in 4 cases (13%). The modified Merle d'Aubigné scores were excellent in 15 cases (47%), good in 13 cases (41%), fair in 2 cases (6%), and poor in 2 cases (6%). Three cases sustained temporary lateral femoral cutaneous nerve injuries. One patient had a superficial wound infection that resolved after debridement. Five patients had posttraumatic arthritis; one of them underwent total hip arthroplasty at 46 months. No cases had quadrilateral screws entering the hip joint. Conclusion The use of DAPSQ with quadrilateral screws is an effective and safe choice for complex acetabular fractures with quadrilateral plate involvement through the single ilioinguinal approach.
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Affiliation(s)
- Haiyang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Ranran Shang
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Xianhua Cai
- General Hospital of Central Theater Command, Wuhan Clinical Medicine College of Southern Medical University, Wuhan, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Chengjing Song
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Yanzhao Chen
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, China
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Fixation of Transverse Acetabular Fractures With Precontoured Plates Alone Causes Fracture Malreduction: A Biomechanical Assessment. J Orthop Trauma 2020; 34:89-94. [PMID: 31567698 DOI: 10.1097/bot.0000000000001637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Precontoured quadrilateral surface buttress (PQSB) plates have grown in popularity for acetabular fracture fixation. However, our experience has pushed us to hypothesize that their use as sole means of fixation may cause fracture malreduction. A biomechanical model was created to investigate this theory. METHODS A transverse acetabular fracture was created and reduced anatomically in 18 synthetic hemipelvises. The reduced hemipelvises were fixated using 3 different techniques. Group A fixation included anterior and posterior column screws plus a suprapectineal pelvic reconstruction plate; group B models were fixed using a PQSB plate only; and group C models were fixed with an anterior column screw and a PQSB plate. Acetabular tracking points were placed before final fixation and used to quantify any postfixation displacement. One-way analysis of variance and Tukey HSD testing were used to determine the significant difference (P < 0.05). RESULTS Models in group B had significant fracture displacement after final fixation when compared with group A and group C models. The average amount of displacement at the anterior column and within the acetabulum was 1.37 mm (95% CI, 1.08-1.65) in group B constructs compared with 0.32 mm (95% CI, 0.22-0.42) and 0.26 mm (95% CI, 0.15-0.38) in groups A and C constructs, respectively. There were no significant differences in displacement after final fixation between group A and group C models. CONCLUSIONS PQSB plates for acetabular fractures cause malreduction when applied in isolation in this biomechanical model. If a PQSB plate is chosen for fixation, we suggest the use of a columnar lag screw at minimum to hold reduction before plate application.
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Andrés-Peiró JV, Teixidor-Serra J, Tomás-Hernández J, Guerra-Farfán EM, Selga-Marsà J, Porcel-Vázquez JA, Molero-García V. Retrospective study of 16 acetabular fractures with involvement of the quadrilateral plate treated with an anterior intrapelvic modified Rives-Stoppa approach. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Berney MJ, Gibbons J, Fitzgerald MK, Cardiff DP, Leonard M. Computational modelling of forces acting on the femur in acetabular fractures: A finite element analysis study. J Orthop 2019; 16:603-618. [PMID: 31708609 DOI: 10.1016/j.jor.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/22/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The rising incidence of acetabular fractures in the elderly presents an increasing surgical challenge due to patient co-morbidities, complex fracture patterns' and osteoporotic bone. Of interest in this study are those of the quadrilateral plate, which are more common in elderly patients with osteoporosis. Following such injuries, the weight-bearing surface of the femoral head moves medially. Non-operative management of these fractures can lead to the acetabulum articulating on the femoral neck increasing the risk of subsequent femoral neck fracture as a result of the altered biomechanics.Using finite element analysis (FEA) this study seeks to understand the changing biomechanics of the proximal femur in such instances and to determine if there is a threshold of femoral head medialisation that can predict probability of femoral neck fracture. METHODS A femoral neck FEA model was created from the CT and MRI scans of a healthy hip. Using FEA, the model was used to apply point loading to the femoral head at the anatomical weight bearing area and subsequent lateralization of this point down to the femoral neck-shaft junction. This simulates the changing forces acting on the femur as the head medialises into a fractured acetabulum. RESULTS As the point of contact moved laterally the stress levels within the proximal femur increased steadily, particularly along the superior neck. Bending moment at the medial neck shaft junction also increased. This increase in stress levels can be seen as a corollary for risk of fracture within the femur. CONCLUSION With medialisation of the femur into a fractured acetabulum there is a significant change in the stress distribution within the femoral neck. Clinically, this is indicates that patients with such injuries are at an increased risk of femoral neck fractures once they begin to mobilise after the initial injury, a devastating result. This model may be of use to treating surgeons in predicting the risk of femoral neck fracture.
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Affiliation(s)
| | - John Gibbons
- Connolly Hospital, Dublin, Ireland.,Tallaght Hospital, Dublin 24, Ireland
| | - Ms Karen Fitzgerald
- School of Mechanical & Materials Engineering, University College Dublin, Ireland
| | - Dr Philip Cardiff
- Bekaert Lecturer in Materials Processing, School of Mechanical & Materials Engineering, University College Dublin, Ireland
| | - Michael Leonard
- Consultant Surgeon in Trauma and Orthopaedics, Tallaght Hospital, Dublin 24, Ireland
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Andrés-Peiró JV, Teixidor-Serra J, Tomás-Hernández J, Guerra-Farfán EM, Selga-Marsà J, Porcel-Vázquez JA, Molero-García V. Retrospective study of 16 acetabular fractures with involvement of the quadrilateral plate treated with an anterior intrapelvic modified Rives-Stoppa approach. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:416-423. [PMID: 31521581 DOI: 10.1016/j.recot.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/12/2019] [Accepted: 06/25/2019] [Indexed: 12/29/2022] Open
Abstract
GOAL To report our experience with the use of Stoppa approach for fractures of the acetabulum with quadrilateral plate involvement. MATERIAL AND METHOD Retrospective study; level iv. All patients were operated in a third level trauma center. The surgical team was experienced in the management of pelvic fractures. Data about patients, injuries, treatment features and clinical and radiological results were collected. We performed a statistical analysis; both descriptive and analytical. RESULT 16 patients integrated the sample. 15 suffered associated fracture patterns. Anatomical plates were used in 15. Four required extended approaches. Reduction was anatomical in 9. 7 suffered some complication, needing the additional surgical procedures in 4. The surgical site infection rate was particularly high, appearing in 3. DISCUSSION Radiological results were within the previously reported. We had a high complication rate, particularly infection. This outcome may be influenced by the special complexity of our cases and the adaptation process to a new technique. CONCLUSSION Using the Stoppa approach we achieved lots of good or anatomical reductions. However, is an exigent and not without complications technique.
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Affiliation(s)
- J V Andrés-Peiró
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - J Teixidor-Serra
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Tomás-Hernández
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E M Guerra-Farfán
- Unidad de Cirugía de Cadera, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Selga-Marsà
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J A Porcel-Vázquez
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - V Molero-García
- Unidad de Traumáticos, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
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Jang CY, Kwak DK, Lee HM, Hwang JH, Yoo JH. Management of anteromedially displaced acetabular fractures using a collinear reduction clamp through modified ilioinguinal approach. Orthop Traumatol Surg Res 2019; 105:889-893. [PMID: 30477813 DOI: 10.1016/j.otsr.2018.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/07/2018] [Accepted: 10/05/2018] [Indexed: 02/02/2023]
Abstract
The authors present a surgical technique using a collinear reduction clamp through the modified ilioinguinal approach (MIA) for anteromedially displaced acetabular fractures along with the surgical outcomes. Between October 2010 and June 2015, 15 patients underwent surgical treatment for anteromedially displaced acetabular fractures; 10 both-column fractures and 5 anterior column and posterior hemitransverse fractures. Anteriorly displaced anterior column fragment and medially displaced quadrilateral plate fragment were simultaneously reduced using a collinear clamp and fixed with a 3.5mm-reconstruction plate through MIA. Postoperatively, anatomical reduction was achieved in 12 patients, while imperfect reduction was achieved in 3. At a mean follow-up of 49.0 months (range, 24-93 months), the mean Postel Merle d'Aubigné score were 16.3 and the mean VAS score was 0.9. Final radiographic grades according to Matta system were excellent in 13 patients and good in 2. Surgical technique using a collinear reduction clamp through the MIA can provide satisfactory outcomes in anteromedially displaced acetabular fractures.
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Affiliation(s)
- Chul-Young Jang
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea
| | - Dae-Kyung Kwak
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea
| | - Hyung-Min Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea
| | - Ji-Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 948-1 Daerim-1 dong, Yeongdeungpo-gu, Seoul 150-950, South Korea
| | - Je-Hyun Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea.
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Precontoured Quadrilateral Surface Acetabular Plate Fixation Demonstrates Increased Stability When Compared With Pelvic Reconstruction Plates: A Biomechanical Study. J Orthop Trauma 2019; 33:e325-e330. [PMID: 31436712 DOI: 10.1097/bot.0000000000001496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the stability of 3 fixation strategies for a transverse acetabular fracture: a reconstruction plate with anterior and posterior column screws (group A); an infrapectineal precontoured quadrilateral surface buttress (iPQSB) plate alone (group B); and an anterior column lag-screw and iPQSB plate (group C). METHODS A transverse acetabular fracture was created in 18 synthetic hemipelvises. Six were fixed by each of the 3 methods described. Specimens underwent cyclic axial compressive loading to 1700N for 42,000 cycles while anterior and posterior column displacements were measured, followed 4800N for 50 cycles. Displacement and stiffness data were analyzed with analysis of variance and Tukey HSD. A Cox proportional hazards regression model was used to determine survival rate. P values < 0.05 were considered significant. RESULTS Group C had significantly less posterior column displacement (0.16 ± 0.06 mm) compared with group B (0.38 ± 0.37 mm, P < 0.0001) and group A (0.38 ± 0.37 mm, P < 0.0001). In addition, group A had significantly more anterior column displacement (0.28 ± 0.11 mm) than group B (0.22 ± 0.14 mm, P = 0.0310) and group C (0.18 ± 0.09 mm, P = 0.0001). Group C was 10.5% stiffer than group A (P = 0.0037). Group B had a 7.27x greater rate of failure than group C (95% confidence interval, 1.6-33.2). DISCUSSION AND CONCLUSION Under anatomical loading, iPQSB plates with anterior column lag-screw fixation demonstrate increased stability in a synthetic bone transverse acetabular fracture model. Based on our data, we support additional evaluation of early weight-bearing after transverse acetabular fracture fixation in patients with healthy bone when an anterior column screw-iPQSB plate construct is used.
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He L, Sun Y, Hou Z, Zhang Q, Hu Y, Bai X, Yi C. The "safe zone" for infrapectineal plate-screw fixation of quadrilateral plate fractures: An anatomical study and retrospective clinical evaluation. Medicine (Baltimore) 2019; 98:e15357. [PMID: 31083163 PMCID: PMC6531153 DOI: 10.1097/md.0000000000015357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the "safe zone" on the quadrilateral surface to facilitate safe plate-screw placement.Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal line, and Z parallel to the posterior border of the ischial body. Then, the distances between X and the iliopectineal line (D1), Y and the sacroiliac joint (D2), and Z and the posterior border of the ischium (D3) could be used to determine a "safe zone" on the quadrilateral surface for screw insertion. We included 15 patients whose conditions satisfied the definition of a comminuted quadrilateral plate fracture and applied two-ended buttress plates for treatment in accordance with this "safe zone."The average D1 was 50.0 mm, the average D2 was 30.6 mm, and the average D3 was 12.4 mm. For all 15 patients with comminuted quadrilateral fracture who were treated, no intraoperative or postoperative screw penetration of the acetabulum was identified, and no loss of reduction was observed during an average follow up of 17.7 months.The "safe zone" established in this study simplifies extraarticular screw placement for managing quadrilateral plate fractures in the true pelvis. As a result, two-ended buttress plate fixation in the true pelvis becomes safe, therefore, treatment with two-ended buttress plates may represent a viable alternative to single-ended elastic fixation in the management of comminuted quadrilateral fractures.
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Affiliation(s)
- Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Yun Sun
- Department of Orthopaedic Surgery, Jiujiang University Hospital, Jiujiang University Clinical Medical College, Xun Yang East Road 57, Jiujiang
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Zi Qiang Avenue 139, Shijiazhuang, China
| | - Qian Zhang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Yinghua Hu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Xiangjun Bai
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
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Use of a stainless steel locking calcaneal plate for quadrilateral plate buttress in the treatment of acetabular fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1141-1145. [PMID: 30848379 DOI: 10.1007/s00590-019-02413-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022]
Abstract
Operative fixation of acetabular fractures involving the quadrilateral surface presents a challenging clinical scenario. Classically, quadrilateral plate buttress was achieved via the use of a "seven" plate. More recently, the use of an anatomic, pre-contoured design has been gaining popularity due to its pre-contoured shape and larger footprint, allowing for a wider quadrilateral plate buttress. The current study presents using a stainless steel locking calcaneal plate to obtain similar surface area coverage as the modern pre-contoured quadrilateral plate, but at a lower cost.Level of evidence IV.
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