A novel anatomically pre-contoured side-specific titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: a propensity-matched cohort study

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Differences in fixation to young and elderly quadrilateral surfaces with anatomic quadrilateral surface plate (AQSP) based on cortical thickness morphological results

“…Therefore, the maintained reduction and buttress provided by internal fixation to the quadrilateral region are essential. Recently, many newly designed prebent suprapectineal or infrapectineal plates have been proposed to buttress the quadrilateral area which was known as a thin cortical region [ 11 – 15 ]. Furthermore, He found and reported that there was a “safe zone” for infrapectineal plate fixation for quadrilateral surfaces, but he did not mention the effect of screw purchase and fixation construct buttress for the thin part of the quadrilateral surface [ 16 ].…”

Inclined angles of acetabular quadrilateral plate: digital measurement and clinical application of the new anatomical concept

“…Secondly, in this study, although the postoperative imaging evaluation of acetabular plate fracture was analyzed in depth, it should be further discussed whether there is a closer relationship between the postoperative imaging evaluation of acetabular plate fracture and patients’ functional outcomes. In our experience, achieving good functional results after acetabular fracture not only lies in the anatomical repositioning of the acetabulum, but also requires patients to adhere to a reasonable rehabilitation after surgery [ 22 ]. Thirdly, in spite of the simplifications in the measurement of these three angles, the measurement steps are still complex, which may hinder clinical promotion and popularization.…”

Modified Stoppa approach for treatment of acetabular fractures

“…Additionally, it could successfully lower the length of the incision, the amount of blood lost during surgery, and the duration of the procedure. For the clinical management of complicated pelvic and acetabular fractures, it could be a preferable option [21] . More studies are required to compare the results as there are a lot of controversies about the indications and safety of the pararectus approach.…”