Objective To compare the clinical efficacy and safety of a personalized three‐dimensional (3D) printed dynamic anterior plate–screw system for the quadrilateral area (DAPSQ) titanium plate and a traditional DAPSQ reconstruction plate in the treatment of double‐column acetabular fractures. Methods This was a retrospective case‐control study. From May 2014 to January 2018, 43 patients with double‐column acetabular fractures underwent open reduction and internal fixation. Among these, 20 cases were fixed with a 3D printed DAPSQ plate (3D printed group) and 23 cases were fixed with a DAPSQ reconstruction plate (control group). The 3D printed group comprised 15 men and 5 women, with an average age of 50.1 ± 8.2 years. The control group comprised 16 men and 7 women, with an average age of 51.0 ± 8.6 years. The evaluation index included the surgical data (i.e. blood loss, operating time, duration of hospital stay, and intraoperative and postoperative complications), position and length of implants, reduction quality, hip function, and related complications. The reduction quality was evaluated using the Matta scoring standard and hip function was evaluated using the modified Merle d’Aubigné score. Results A total of 43 patients met the inclusion criteria. The mean postoperative follow up was 35.2 months in the 3D printed group and 36.9 months in the control group. There were no significant group differences in demographic data between the two groups. The position and length of the 3D printed implants were generally in accord with preoperative planning using a 3D pelvic model. Patients in the 3D printed group had significantly shorter operation time (223.2 vs 260.5 min, P < 0.05) and less intraoperative blood loss (930.4 vs 1426.1 mL, P < 0.05) compared to the control group. Anatomic, imperfect, and poor reduction was obtained in 13, 5, and 2 cases in the 3D printed group, respectively, and was obtained in 12, 8, and 3 cases in the control group. The modified Merle d’Aubigné scores were excellent in 11 cases, good in seven cases, and fair in two cases in the 3D printed group. They were excellent in 11 cases, good in eight cases, fair in three cases, and poor in one case in the control group. The reduction quality and hip function did not differ within the groups (P > 0.05). The general complication rate in the 3D printed group and the control group was 15% and 26.1%, respectively, but the difference between the two groups was not statistically significant. Conclusion Use of a personalized 3D printed DAPSQ plate has potential advantages in reducing the operation time and blood loss during the treatment of double‐column acetabular fractures.

Objectives: To evaluate the efficacy and safety of a novel fixation technique referred to as the dynamic anterior platescrew system for quadrilateral plate (DAPSQ) for complex acetabular fractures with quadrilateral plate involvement through the single ilioinguinal approach.Methods: A total of 32 patients with acetabular fractures, 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.

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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.

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.