Open reduction and internal fixation of quadrilateral plate fractures in the elderly: association between initial fracture pattern and outcomes

Abstract

Background Acetabular fractures with medial displacement of the quadrilateral plate (QLP) are common in the elderly. The presence of QLP fractures greatly increase the surgical difficulty of acetabular fractures. This study aims to evaluate the clinical radiological outcomes of open reduction and internal fixation (ORIF) in QLP fractures in elderly patients and to investigate factors potentially affecting the result. Methods We conducted a retrospective study. A series of 37 consecutive patients with acetabular fracture involving the QLP aged 60 years and older who received ORIF between January 2010 and May 2019 were included. QLP fractures were classified according to Walid’s classification system. Radiological outcomes were evaluated using Matta criteria and functional outcomes were assessed using the modified Merle d’Aubigné score. The relationships between Walid’s classification and radiological or functional outcomes were analyzed. Results According to Walid’s classification, 18, 13, 6 were classified as QLP1, QLP2 and QLP3, respectively. The average follow-up was 35.5 ± 10.7 months. We obtained anatomic reduction in 48.6 % (18/37) of cases, imperfect reduction in 40.5 % (15/37) of cases, and poor reduction in 10.8 % (4/37) of cases. Excellent-good functional scores were found in 83.7 % (modified Merle d’Aubigné). There were no cases of screw entering the hip, pull-out and loosening or implant failure during the follow-up. Walid’s classification was positively correlated with radiological outcomes of reduction (r = 0.661; P < 0.001), and functional outcomes (r = 0.478; P = 0.003). Unsatisfactory reduction was demonstrated a correlation with the development of post-traumatic arthritis (r =-0.410; P = 0.012). Conclusions ORIF may be suggested for quadrilateral plate fractures in the elderly. Walid’s classification system is associated with the reduction quality and functional recovery.

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

“…Due to the extremely complex structure of the acetabulum, it is unrealistic to perform 3D quantitative analysis of its morphology under gross anatomy or X-ray images. In contrast, the structure of the medial area is relatively flat, so quadrilateral plate may indirectly reflect acetabular fracture reduction by studying this area [ 11 ]. The greater sciatic notch, sciatic spine, obturator foramen and pelvic boundary were usually used as marks to describe and locate the quadrilateral plate.…”

“…As the fixation of fracture blocks in quadrilateral plate, a novel internal fixation system called the dynamic anterior plate-screw system for quadrilateral plates (DAPSQ) designed by our group was used. The detailed operation steps of DAPSQ were described in our previous reports [ 11 , 12 ].…”

Preemptive pericapsular nerve group block to facilitate sitting position for neuraxial anesthesia in patients with acetabular fractures: A case series

“…They have bimodal distribution with the younger patients due to high-energy trauma (e.g., motor vehicle accidents) and elderly patients due to low-energy trauma (e.g., fall on the floor or from height). [ 10 ] The most common type of fractures in the younger include posterior wall or transverse type fractures, whereas the elders include anterior column, posterior hemi-transverse, or column fractures. Approximately 80.5% of acetabular fractures result from motor vehicle accidents, and 10.7% result from falls.…”

Acetabular fractures treatment needs in the elderly and nonagenarians

“…All of them give an overview of the complexity and stability of acetabular fractures and aim to provide surgical decision-making for young adults, but it is a complex system. However, there is no direct recommendation to facilitate the choice of the right operative treatment ( 16 , 18 , 19 ). The anterior and posterior pillars of the acetabulum and walls must be, as anatomically as possible, reduced and fixed and transverse fractures are observed above or within the hip joint.…”