Are Quadrilateral Surface Buttress Plates Comparable to Traditional Forms of Transverse Acetabular Fracture Fixation?

Kistler, Brian J.; Smithson, Ian R.; Cooper, Seth A.; Cox, Jacob L.; Nayak, Aniruddh N.; Santoni, Brandon G.; Sagi, H. Claude

doi:10.1007/s11999-014-3800-x

Cited by 58 publications

(68 citation statements)

References 17 publications

(28 reference statements)

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“…We adopted a loading methodology similar to those mentioned by Chang et al 17 and Kistler et al 18 . Similarly, the composite hemipelvis and femur (Sawbones; Pacific Research Laboratories) were coupled in a 3-dimensional model and the axis of the femoral neck was used as the biomechanical loading vector (SOLIDWORKS 2017; Dassault Systèmes SolidWorks).…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly

Chen

Yang

Yao

et al. 2020

Journal of Bone and Joint Surgery

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Background: Anterior column-posterior hemitransverse fractures are prevalent in the elderly and are often associated with quadrilateral surface (QLS) comminution. Several special QLS buttress plates have been introduced, but evidence of their comparability with traditional fixation devices is lacking. This biomechanical study aimed to compare special QLS buttress plates with traditional fixation devices. Methods: Anterior column-posterior hemitransverse fractures with an isolated QLS fragment were created on 24 composite hemipelves and were allocated to 4 fixation groups: (1) infrapectineal QLS buttress plate, (2) suprapectineal QLS buttress plate, (3) suprapectineal reconstruction plate with 3 periarticular long screws, and (4) infrapectineal reconstruction plate with 3 periarticular long screws. Specimens were loaded to simulate partial weight-bearing (35 to 350 N) or full weight-bearing (75 to 750 N). A testing machine was synchronized with a 3-dimensional video tracking system to optically track displacement at the points of interest and to calculate construct stiffness. The fixation systems were compared using the Kruskal-Wallis and Mann-Whitney U tests. Results: The experimental results of the partial and full weight-bearing simulations were surprisingly similar. During 40 loading cycles, the maximum displacement on the 6 predetermined points did not exceed 1.1 mm. Multiple-group comparisons of relative displacements of each predetermined measurement point did not differ significantly (p > 0.05). The suprapectineal reconstruction plate with 3 periarticular long screws demonstrated the greatest construct stiffness and significantly greater stiffness than the infrapectineal plate with long screws (p < 0.017). However, no significant difference (p > 0.017) in stiffness was identified between the infrapectineal QLS buttress plate and the suprapectineal reconstruction plate with long screws. Conclusions: The suprapectineal pelvic brim plate with 3 periarticular long screws remains the gold standard to treat anterior column-posterior hemitransverse fractures. The special infrapectineal QLS buttress plate provides stiffness and stability comparable with those of standard fixation. However, moving the pelvic brim plate from the suprapectineal border to the infrapectineal border is not recommended for anterior column-posterior hemitransverse fractures because it significantly decreases fixation stiffness. Clinical Relevance: Special QLS buttress plates may be an alternative fixation method for anterior column-posterior hemitransverse acetabular fractures in the elderly, especially when a less invasive anterior intrapelvic approach is selected.

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Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly

Chen

Yang

Yao

et al. 2020

Journal of Bone and Joint Surgery

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“…They are precontoured and a single implant can stabilise the anterior column and buttress the quadrilateral plate to prevent medial migration of the head. Kistler et al 14 in an in vitro study found the quadrilateral buttress plates superior to standard forms of fixation in resisting motion at the fracture and medial subluxation.…”

Section: Discussionmentioning

confidence: 98%

Dual mobility total hip dislocation—femoral stem loosening while attempting closed reduction: a cautionary note

Dotivala¹,

Coomber

Chowdhry

et al. 2018

BMJ Case Reports

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A 77-year-old man sustained an acetabular fracture after falling from a staircase and landing on his right side. He fractured the anterior column of his acetabulum and the quadrilateral plate. He underwent a single-stage open reduction and internal fixation of the fracture combined with a dual mobility total hip arthroplasty (THA). He sustained a traumatic hip dislocation 1 month postoperatively. Closed reduction was attempted at another hospital, and the femoral stem was pulled out. We believe this was caused by the polyliner being hitched either to the acetabular cup or in the soft tissues around the ilium. We present this case to caution orthopaedic surgeons that dual mobility THA dislocations are difficult to diagnose as the polyliner is not clearly seen on X-rays, and reduction attempts may lead to worsening of an already difficult situation.

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“…Owing to the limitation of the minimal incision in our study, the bone surface was not exposed fully, which made it di cult and time-consuming to reshape plate during operation. In recent years, some new anatomic plates instead of conventional reconstruction plate have been used for buttress and span xation of the quadrilateral plate and medial surface of the posterior column (17,24). The anatomic plates have good biomechanical properties and congruity with the irregular acetabulum surface, which make the xation more valid.…”

Section: Discussionmentioning

confidence: 99%

Internal Fixation of Anterior Acetabular Fractures with a Limited Pararectus Approach and the New Anatomical Plates: Preliminary Results

Yao

Chen

Zhu

et al. 2020

Preprint

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Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the new anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with minimally invasive approach and the new anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The new anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the new anatomical plates successfully. The mean operative time and blood loss were 90.9 minutes and 334.1 ml, respectively. The average postoperative residual gap and step displacement were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.Conclusions The limited pararectus approach with the advantages of more minimally invasive and less complications can be an alternative choice for simple anterior acetabular fractures especially involving the quadrilateral plate. The new anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction.

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Are Quadrilateral Surface Buttress Plates Comparable to Traditional Forms of Transverse Acetabular Fracture Fixation?

Abstract: Background Several construct options exist for transverse acetabular fracture fixation.

Cited by 58 publications

References 17 publications

Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly

Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly

Dual mobility total hip dislocation—femoral stem loosening while attempting closed reduction: a cautionary note

Internal Fixation of Anterior Acetabular Fractures with a Limited Pararectus Approach and the New Anatomical Plates: Preliminary Results

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