Anatomical quadrilateral plate for acetabulum fractures involving quadrilateral surface: A review

Sen, Ramesh Kumar; Saini, Gaurav; Kadam, Sagar; Raman, Neha

doi:10.1016/j.jcot.2020.10.013

Cited by 21 publications

(17 citation statements)

References 37 publications

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“…Second, elderly individuals have more systemic diseases, limiting the duration of the operation. Finally, most acetabular fractures in elderly individuals are comminuted fractures [ 23 ], which cannot be fixed using ordinary plates. Acetabular fractures in elderly individuals are not the same as those in other individuals.…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

et al. 2022

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Background Elderly acetabular fractures are one of the more difficult types of fractures to resolve. For patients at this age, the more common type of fracture is comminuted. How to better fix this type of fracture has always been an issue of concern. This study was performed to observe the mechanical properties of different internal fixation methods used in treating elderly acetabular fracture patients. Methods A model of a comminuted acetabular fracture in osteoporosis was established, consisting of an anterior column–posterior hemitransverse fracture with disruption of the quadrilateral surface. Fixation of the acetabular fracture model using a reconstruction plate and Union Plates was simulated. For the different internal fixation methods, static and transient modal analyses were performed under different loads, with an action time of 0.21 s and an analysis time of 0.7 s. The stress of the model was observed in the static analysis, and the displacement of the nodes and the entire model in the U1 direction was observed in the transient modal analysis. Results In the static analysis, the stress of the osteoporosis model, the suprapectineal pelvic reconstruction plate model, the infrapectineal quadrilateral surface buttress plate model, and the suprapectineal quadrilateral surface buttress plate model were 42.62 MPa, 37.49 MPa, 44.39 MPa, and 46.15 MPa, respectively. The stress was mainly distributed near the suprapubic branch. The corresponding displacement in the U1 direction was 0.1500 mm, 0.1020 mm, 0.0836 mm, and 0.0990 mm, respectively. In the transient modal analysis, there was a significant difference in displacement between the different models (P < 0.05). When different loads were applied with the same fixation method, there was no significant difference in model displacement (P > 0.05). Conclusion Static and transient modal analyses show that the infrapectineal quadrilateral surface buttress plate or the suprapectineal quadrilateral surface buttress plate has an advantage in maintaining the stability of fracture fragments when fixing comminuted acetabular fractures in elderly individuals. The infrapectineal quadrilateral surface buttress plate also presents better biomechanical results.

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Section: Discussionmentioning

confidence: 99%

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

et al. 2022

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“…Postoperative results were similar with other published studies. 6 , 22 The three patients with poor clinical results might be due to their own severe osteoporosis that hindered the union of bone. The incidence rate of postoperative complications was 17.39% including incision‐related iatrogenic injuries such as lateral femoral cutaneous nerve injury; these complications generally resolved within 1 month, except for heterotopic ossification.…”

Section: Discussionmentioning

confidence: 99%

“…4 , 5 However, it is difficult for orthopedic surgeons to manage this particular type of injuries due to co‐morbidities associated with age‐related bone quality and osteoporosis resulting in comminuted fractures of QLS. 6 …”

Section: Introductionmentioning

confidence: 99%

The novel infra‐pectineal buttress plates used for internal fixation of elderly quadrilateral surface involved acetabular fractures

Wan

Yao

et al. 2022

Orthopaedic Surgery

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Objectives In geriatric acetabular fractures, the quadrilateral surface (QLS) was frequently involved in acetabular fracture patterns and accompanied by medial displacement. It was important to buttress the medial displaced QLS and reconstruct the congruity of the affected acetabulum. To evaluate the clinical effectiveness of the novel infra‐pectineal quadrilateral surface buttress plates for the treatment of geriatric acetabular fractures. Methods Twenty‐three geriatric patients who were treated for acetabular fractures involving QLS with the novel infra‐pectineal buttress plates (NIBP) through a single supra‐ilioinguinal approach between January 2015 and June 2019 were retrospectively analyzed; all patients received at least 1 year's follow‐up. All patients were aged ≥60 years old and including 18 males and five females. Radiologic and clinical outcomes of patients involved in the study were collated and analyzed according to the Matta scoring system and the Merle D'Aubigné–Postel scoring system. The functional recovery scoring was compared using q‐test. Results All 23 consecutive patients had relatively satisfactory clinical treatment effectiveness. Average ages, length of incision, operation time, and intraoperative blood loss were 69.8 ± 6.1 years, 12.1 ± 2.6 cm, 166.5 ± 43.5 min, and 500 (500,700) ml, respectively. According to the Matta scoring system, 14 cases of reduction were graded as excellent, five as good, and four as fair. At the last follow‐up, the clinical outcome evaluation was excellent in 13 cases, good in seven cases, and poor in three cases with the use of the Merle D'Aubigné–Postel scoring system. The difference of modified Merle D'Aubigne‐Postel score at 3 months, 6 months and last follow up was statistically significant (F = 21.56, p < 0.05). Postoperative lateral femoral cutaneous nerve injury occurred in three patients and heterotopic ossification occurred in one patient. Conclusions For the treatment of geriatric acetabular fractures, the NIBP could provide stable and effective fixation to the QLS involved acetabular fractures, and related satisfactory clinical results with few complications were noted.

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“…However, it only provided resistance to the hip not formed desired buttress effect to the QLS, if the gap was existing between the screws and the QLS, the tendency of reduction loss would never disappear. Kistler et al[35] and R.K. Sen et al [21] published their innovation of QLS buttress plates, their plates provided partial buttress and resistant effect to the broken QLS reducing the rate secondary displacement of fractures. Chen et al reported biomechanical comparison of different xation techniques including a special infrapectineal QLS buttress plate, compared with other plates, which not only provided entire buttress and resistant effect to the broken QLS especial the comminuted fractures, but also formed entire frame of the QLS.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some scholars invented variant types of internal xations to x acetabular fractures involving the QLS using above access including the reconstruction plates, lag screws and cerclage wires/cables. [15][16][17][18][19][20][21] Nevertheless, the xation protocol is the same except slight differences. Ulf Culemann et al [22] introduced an novel technique for an additional long infra-acetabular screw placement to form "frame" structure consisting of both columns, the ilioinguinal plate and supra-acetabular screw xation, which achieved a rigid xation for acetabular fractures and prevent displacement of fractured segments.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Geriatric Acetabular Anterior Fractures: Role of “Frame and Buttress”

Wan¹,

Ma²,

Yao³

et al. 2021

Preprint

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Background: As the rate of geriatric acetabular fractures was increasing gradually and accompanied with the quadrilateral surface(QLS) involved resulting by impacting from the head of femur, which usually leaded to the dislocation/subluxation of the head of femur and intra-pelvic medial displacement of the QLS. Traditionally, applying an infra-pectineal buttress plate in the true pelvis to resist the protrusive fragments of the QLS, however, these plates with small contact area could not provide enough buttress effect to age-related fractures. This study was to evaluate the “frame and buttress” fixation strategy for treatment of geriatric acetabular anterior fractures(GAAF).Methods: A cohort of 28 patients with acetabular fractures involving QLS were managed operatively with the “frame and buttress” fixation strategy with a single pelvic anterior approach. 7 cases were transverse, 3 cases were posterior column, 8 cases were associated both columns, 4 cases were anterior posterior hemi-transverse and 6 cases were T-type patterns fracture. The quality of reduction, functional outcomes and complicates were recorded for analyzing.Results: Functional outcomes were 15 cases in excellent; 9 cases were good; 3 cases were fair, and 1 case was poor. The quality of surgical reduction was evaluated by the Matta score system, which was graded as excellent in 17 cases, good in 9 cases and poor in 2 cases, respectively. No loss or failure of internal fixation, no second dislocation/subluxation of femoral head and no complications like infection were observed.Conclusions: The “frame and buttress” fixation strategy provided firm method for treating GAAF, the “frame” formed rigid fixation structure for acetabular fractures and the “buttress” resisted protrusive QLS.

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Anatomical quadrilateral plate for acetabulum fractures involving quadrilateral surface: A review

Cited by 21 publications

References 37 publications

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

Finite element analysis of the Union Plate in treating elderly acetabular fracture patients

The novel infra‐pectineal buttress plates used for internal fixation of elderly quadrilateral surface involved acetabular fractures

Treatment of Geriatric Acetabular Anterior Fractures: Role of “Frame and Buttress”

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