• Acetabular protrusion
• Classification
• Reconstruction
• Total hip arthroplasty

• Acetabular fracture
• Anatomy
• Biomechanics
• Classification
• Quadrilateral plate fracture
• Stabilization concepts

• Humans
• Fracture Fixation, Internal/methods
• Fracture Fixation, Internal/instrumentation
• Acetabulum/injuries
• Acetabulum/surgery
• Fractures, Bone/surgery
• Fractures, Bone/diagnostic imaging
• Fractures, Bone/classification
• Bone Plates
• Fractures, Comminuted/surgery
• Fractures, Comminuted/diagnostic imaging
• Bone Screws

• Bone Plates
• Humans
• Finite Element Analysis
• Bone Screws
• Fracture Fixation, Internal/methods
• Fracture Fixation, Internal/instrumentation
• Cadaver
• Fractures, Bone/surgery
• Biomechanical Phenomena
• Acetabulum/injuries
• Acetabulum/surgery
• Male
• Titanium
• Female

• 81601902 The National Natural Science Foundation of China
• 2015CFB240 The Natural Science Foundation of Hubei Province
• 2015M572817 The China Postdoctoral Science Foundation
• YZ201414 The Wuhan General Hospital Fund Grant Program

• ACpHT
• Acetabulum
• Anterior column–posterior hemitransverse
• Pathoanatomy
• Pelvic trauma

• Humans
• Acetabulum/injuries
• Acetabulum/diagnostic imaging
• Retrospective Studies
• Male
• Female
• Fractures, Bone/diagnostic imaging
• Fractures, Bone/surgery
• Tomography, X-Ray Computed
• Middle Aged
• Aged
• Fractures, Comminuted/diagnostic imaging
• Fractures, Comminuted/surgery
• Aged, 80 and over

• acetabular fracture fixation
• acetabulum
• ilioinguinal approach
• quadrilateral plate
• technique

• Anatomical landmarks
• Infra-acetabular screw
• Insertion point and angle
• Pelvic inlet plane

• Humans
• Acetabulum/surgery
• Acetabulum/injuries
• Acetabulum/diagnostic imaging
• Bone Screws
• Male
• Fracture Fixation, Internal/methods
• Fracture Fixation, Internal/instrumentation
• Female
• Retrospective Studies
• Fractures, Bone/surgery
• Fractures, Bone/diagnostic imaging
• Adult
• Middle Aged
• Tomography, X-Ray Computed
• Aged
• Sacroiliac Joint/surgery
• Sacroiliac Joint/diagnostic imaging
• Sacroiliac Joint/injuries

• acetabulum quadrilateral surface fractures
• functional scores
• interfragmentary lag screw
• radiological scores
• sbst plate

• Humans
• Acetabulum/surgery
• Acetabulum/injuries
• Acetabulum/diagnostic imaging
• Bone Plates
• Female
• Male
• Fracture Fixation, Internal/methods
• Fracture Fixation, Internal/instrumentation
• Bone Screws
• Middle Aged
• Adult
• Fractures, Comminuted/surgery
• Fractures, Comminuted/diagnostic imaging
• Treatment Outcome
• Retrospective Studies
• Fractures, Bone/surgery
• Fractures, Bone/diagnostic imaging

• Associated both-column acetabular fractures
• Fracture lines
• Fracture mapping
• Quadrilateral plate fragments

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.

In geriatric acetabular fractures, the quadrilateral surface (QLS) was frequently involved in acetabular fracture patterns and accompanied by medial displacement. It was important to buttress the medial displaced QLS and reconstruct the congruity of the affected acetabulum. To evaluate the clinical effectiveness of the novel infra‐pectineal quadrilateral surface buttress plates for the treatment of geriatric acetabular fractures.

Twenty‐three geriatric patients who were treated for acetabular fractures involving QLS with the novel infra‐pectineal buttress plates (NIBP) through a single supra‐ilioinguinal approach between January 2015 and June 2019 were retrospectively analyzed; all patients received at least 1 year's follow‐up. All patients were aged ≥60 years old and including 18 males and five females. Radiologic and clinical outcomes of patients involved in the study were collated and analyzed according to the Matta scoring system and the Merle D'Aubigné–Postel scoring system. The functional recovery scoring was compared using q‐test.

All 23 consecutive patients had relatively satisfactory clinical treatment effectiveness. Average ages, length of incision, operation time, and intraoperative blood loss were 69.8 ± 6.1 years, 12.1 ± 2.6 cm, 166.5 ± 43.5 min, and 500 (500,700) ml, respectively. According to the Matta scoring system, 14 cases of reduction were graded as excellent, five as good, and four as fair. At the last follow‐up, the clinical outcome evaluation was excellent in 13 cases, good in seven cases, and poor in three cases with the use of the Merle D'Aubigné–Postel scoring system. The difference of modified Merle D'Aubigne‐Postel score at 3 months, 6 months and last follow up was statistically significant (F = 21.56, p < 0.05). Postoperative lateral femoral cutaneous nerve injury occurred in three patients and heterotopic ossification occurred in one patient.

For the treatment of geriatric acetabular fractures, the NIBP could provide stable and effective fixation to the QLS involved acetabular fractures, and related satisfactory clinical results with few complications were noted.

• Buttress
• Geriatric acetabular fractures
• Internal fixation
• Medial displacement
• Quadrilateral surface

• Anterior pelvic approaches
• Neurovascular injury
• Pelvic fracture
• Pelvis
• Surgical site infection

• Buttress plate
• Ilio-inguinal approach
• Matta criteria
• Quadrilateral plate fractures
• Stoppa approach
• infra-pectineal plate

With relatively thinner cortical thickness, the management of acetabulum osteoporotic fractures in elderly patients is difficult. The aim of the research was to compare and present the morphological characteristics of the quadrilateral plate in young and elderly age groups, such as the area, and position distribution of the thin cortical thickness region, fracture lines maps, and propose a revised design plate for elderly patients based on these anatomic information.

As a retrospective research, acetabular fracture with one normal hemipelvises, including 110 men and 39 women, were collected to present the morphological characteristics of the quadrilateral region. The subjects were divided into three different age groups: Group I = 18–40 years (31.3 ± 6.6 years), Group II = 41–60 years (49.9 ± 5.3 years), and Group III ≥ 61 years (68.7 ± 6.8 years). The area of the quadrilateral surface, the area and position distribution of the thin cortical thickness region, the ratio and fracture lines maps were calculated and compared with Mimics in different groups.

The thin cortical thickness/width region area (TCWRA) was significantly increased in Group III compared with Group I and Group II. The ratio of TCWRA accounted for in the quadrilateral region was also significantly increased in Group III (≥ 61 years) compared with Group I (P = 0.01) and Group II (P = 0.011). None of the subjects had a component involving the “A” zone, thirty-three thin cortical thickness regions were located in the “B” zone, and one hundred and sixteen involved both zones of the quadrilateral plate (“A + B” zone). Furthermore, there were a significant differences in the fracture line distributions in three age groups. More fracture lines of elderly patients were located at anterior part (B zone) compared with Group I and Group II.

It was identified the area of thin cortical thickness region increased as age grown, and fracture lines were inclined to be more distributed in “B” zone in elderly patients. To meet the demands of acetabular fixation in different age groups, cortical thickness changes in young and elderly individuals should be given special attention when the quadrilateral surface plate is designed.

Level of evidence Level IV, observational study.

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.

• Acetabular fracture
• Quadrilateral plate
• Fracture classification
• Operative approach
• Implant
• Internal fixation

• Acetabular fracture
• Anterior column
• Anterior intrapelvic approach to the acetabulum
• Quadrilateral surface
• Suprapectineal plate

• Acetabulum/diagnostic imaging
• Acetabulum/surgery
• Bone Plates
• Fracture Fixation, Internal/adverse effects
• Fractures, Bone/diagnostic imaging
• Fractures, Bone/epidemiology
• Fractures, Bone/surgery
• Hip Fractures
• Humans
• Middle Aged
• Retrospective Studies
• Treatment Outcome

• Università Cattolica del Sacro Cuore

• acetabular fracture
• fixation
• omega plate
• trauma
• treatment

With the modernization of society and transportation in the last decades in China, the incidence of high-energy trauma increased sharply in China, including that of acetabular fractures.

To establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.

The three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer. After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity, the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones.

In the standing position, the maximum stress was 46.21 MPa. In the sitting position, the sacrum bore the simulated gravity load at the upper end. When comparing the five fixations, there were no significant differences in the stress mean values among groups (sitting: P = 0.9794; standing: P = 0.9741). In terms of displacement, the average displacement of the internal iliac plate group was smaller than that of the spring plate group (P = 0.002), and no differences were observed between the other pairs of groups (all P > 0.05). In the standing position, there were no significant differences in the mean value of displacement among the groups (P = 0.2985). It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment.

There were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.

• Acetabulum
• Hip fractures
• Analysis
• Finite element
• Fracture fixation
• Orthopedic fixation devices

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.

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.

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.

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.

• Acetabular fractures
• Anterior intrapelvic approach
• Infrapectineal plate
• Modified Stoppa approach
• Quadrilateral plate

• Acetabulum fracture
• Fracture fixation
• Quadrilateral surface plate

• Acetabulum fracture
• Medial wall
• Quadrilateral plate

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.

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.

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.

The 3DPPS Ti-6AL-4 V plate is a feasible, accurate and effective implant for acetabular fracture treatment.

• 3D printing patient-specific plates
• Acetabular fractures
• Patient-specific implants
• Quadrilateral plate disruption
• Virtual surgical planning

Surgical treatment of acetabular fractures involving a quadrilateral plate is a challenge to orthopedic surgeons. We have developed a novel fixation technique using a specially shaped reconstruction plate combined with several buttress screws of a quadrilateral plate which was also called a dynamic anterior plate-screw system for quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005 (RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, standardized titanium plate (STP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures.

We led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the STP group during the inclusion period (2016–2018) and were matched to 22 cases in our database of the RP group (2008–2016). The primary outcome measures were the quality of reduction and functional outcomes. Intraoperative conditions were also compared.

Of these 22 consecutive patients in the STP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture (12 cases, 54.5%) according to Letournel-Judet classification. The mean follow-up period was 23.1 months (range 12–37). There were no significant differences between the two groups with regard to the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score (P > 0.05). Compared with the RP group, the STP group had a shorter operation time (245.1 min vs. 286.8 min, P = 0.020), less intraoperative blood loss (1136.4 mL vs. 1777.3 mL, P = 0.014), and transfusion (780.9 vs. 1256.8 mL, P = 0.035). The complication rate was 18.2% in the STP group, and there was no significant difference compared with the RP group (36.4%) (P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure.

The fixation of standardized titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The standardized titanium plate of DAPSQ has the advantages of a short operation time, less intraoperative bleeding, and blood transfusion, and it is worth further promotion and research.

• Acetabular fracture
• Fixation
• Fracture reduction
• Models
• Quadrilateral
• Reconstruction plate

• Acetabular fracture
• Digital measurement
• Quadrilateral plate
• Screw placement

• Acetabulum/diagnostic imaging
• Acetabulum/surgery
• Adult
• Aged
• Bone Screws
• Female
• Fracture Fixation
• Fractures, Bone/diagnosis
• Fractures, Bone/surgery
• Humans
• Imaging, Three-Dimensional
• Male
• Middle Aged
• Retrospective Studies
• Tomography, X-Ray Computed

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.

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.

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.

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.

• Acetabular fracture
• Acetabulum reconstruction
• Ilioinguinal approach
• Quadrilateral

• Acetabular fracture
• Geriatric trauma
• Protrusio
• Trauma

• Acetabular fracture
• Anteromedially displaced
• Collinear reduction clamp
• Modified ilioinguinal approach

• Gerota's fascia
• Toldt's fascia
• Waldeyers' fascia
• Zuckerkandl's fascia
• obturator fascia
• pectineal ligament, pectineal fascia
• tendinous arch of levator ani, iliopubic tract

• acetabulum
• fracture fixation
• fractures bone
• modified stoppa

• Acetabulum/injuries
• Acetabulum/surgery
• Adult
• Blood Loss, Surgical
• Bone Plates
• Female
• Follow-Up Studies
• Fracture Fixation, Internal/instrumentation
• Fracture Fixation, Internal/methods
• Fracture Healing
• Fractures, Bone/surgery
• Humans
• Male
• Operative Time
• Retrospective Studies

This study aimed to evaluate outcome following a single lateral rectus abdominis surgical approach for complicated acetabular fractures, involving anterior and posterior columns.

From January 2012 to March 2016, 59 patients, including 36 anterior column hemitransverse fractures, 18 two-column fractures, and five T-type complicated acetabular fractures, were treated with a single lateral rectus abdominis approach and fixed by plates and cannulated lag screws. Anterior column fractures were fixed with 3.5 mm reconstruction plates; posterior column fractures were fixed with 6.5 mm cannulated lag screws. The quality of surgical reduction (using the Matta criteria), functional outcome (using the modified Merle d’Aubigné and Postel scoring system), and postoperative complications were assessed with 24-month follow-up.

Fifty-nine patients (mean age, 45 years; range, 18–64 years) including 39 men and 20 women underwent surgery. Mean intraoperative blood loss was 514.6 ml (range, 150–830 ml) and mean operating time was 86.3 min (range, 42–145 min). Anatomical reduction was good in 40 cases (67.8%), fair in 15 cases (25.4%), and poor in four cases (6.8%). The modified Merle d’Aubigné score was excellent in 39 cases (66.1%), good in 14 cases (23.7%), fair in five cases (8.5%), and poor in one case (1.7%). At follow-up, there were five cases of peritoneal damage, eight cases of obturator nerve dysfunction, and four cases of postoperative traumatic arthritis.

The single lateral rectus abdominis surgical approach for the treatment of complicated acetabular fractures was minimally invasive with good anatomical exposure and good outcomes.

• Biomechanical
• Dynamic loading
• Infrapectineal plate
• Static loading
• Stiffness
• Stoppa
• Suprapectineal plate

• Acetabulum/surgery
• Artificial Organs
• Biomechanical Phenomena
• Bone Plates
• Bone Screws
• Equipment Design
• Fracture Fixation, Internal/instrumentation
• Fracture Fixation, Internal/methods
• Fractures, Bone/surgery
• Humans
• Joint Instability/prevention & control
• Joint Instability/surgery
• Materials Testing
• Pelvis
• Simulation Training
• Stress, Mechanical
• Weight-Bearing

• Acetabular
• Classification
• Fractures
• Quadrilateral