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

Abstract

Aims 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. Methods 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. Results 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. Conclusions 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.

Biomechanical study of different fixation constructs for anterior column and posterior hemi-transverse acetabular fractures: a finite element analysis

“…However, the SP & PP fixation construct was the most stable among all models simulating the sitting position. These findings are similar to those obtained from other biomechanical tests [ 1 , 7 , 16 ].…”

“…Acetabular fractures have become a common phenomenon, and its surgical treatment has always been a challenge for orthopaedic trauma surgeons [ 1 ]. The gold standard treatment consists of early anatomical reduction and adequate internal fixation, thereby allowing for effortless mobility and early recovery [ 2 , 3 ].…”

Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: an anatomical–morphological study

“…Zhang et al [ 22 ] used the Mimics software to measure the safe range of quadrilateral screw placement; they made a clear definition of the “safe zone” and “dangerous zone” of screw placement, which greatly helped to quickly determine the optimal placement of screws during surgery. Guo et al [ 23 ] used the Mimics software to measure and analyze the area and position of the thin cortical bone area of the quadrilateral surfaceand found that the area of the thin cortical bone area of the quadrilateral surfaceincreased with age. Therefore, special attention should be paid to changes in cortical bone thickness in young and old individuals when designing a fixation device for the quadratus body.…”

Third-Generation Dynamic Anterior Plate-Screw System for Quadrilateral Fractures: Digital Design Based on 834 Pelvic Measurements

“…Zhang et al [ 24 ] have measured the thickness of the quadrilateral plate by using Mimics and proposed the “safe zone” for screw placement and the “danger zone” that is not recommended to place screws. Another digital anatomical measurement conducted by Guo and colleagues has found that the thinner area in the quadrilateral region increased with age, suggesting that the age factor should be considered when designing fixation devices for the quadrilateral area [ 25 ]. In addition, Mimics plays an important role in 3D printing technology and virtual surgery simulation [ 26 , 27 ].…”