Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

Abstract

OBJECTIVE:The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area.METHODS:A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1) group A, the normal pelvis and (2) group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations.RESULTS:As the load was added, the displacements were A<B, increasing in line. In the 600 N physiological loading, the differences were significant (standing position: p = 0.013; sitting position: p = 0.009) between groups A and B.CONCLUSION:The anterior construct plate - 1/3 tube buttress plate fixation provided a better stable construct for early sitting. The standing mode yielded more significant differences between the groups. Placing a 1/3 tube buttress-plate via an anterior approach is a novel method of providing quadrilateral area support in this setting.

Single Ilioinguinal Approach to Treat Complex Acetabular Fractures with Quadrilateral Plate Involvement: Outcomes Using a Novel Dynamic Anterior Plate–Screw System

“…The results showed that the stress conduction of the acetabulum was basically consistent with the normal biomechanical conduction of pelvis. In the further biomechanical test with the cadaver, the results showed that compared with an anterior construct plate plus 1/3 tube buttress plate, the stability of the pelvis following our fixation method was stronger in both sitting and standing positions, which was more in line with the biomechanical principles of internal fixation such as neutrality, tension band, pressure band, and load sharing .…”

“…Letoumel et al achieved good effect combined with a lag screw fixation in the posterior column but also could not directly fix the fracture fragments of the quadrilateral plate; it is difficult to insert the screw, especially when the fracture is comminuted or there is severe osteoporosis. Other scholars have applied the technology of buttress plate, such as the T‐shaped plate, the L‐shaped plate, the butterfly plate, the omega plate, or the one‐third tubular plate to fix quadrilateral fracture. Subsequently, several scholars have reported a successful experience when using a buttress plate for osteopenic acetabular fractures involving the quadrilateral plate.…”

Biomechanical comparison of fixation systems in posterior wall fracture of acetabular by finite element analysis

“…Figure 4 shows the stress and displacement distributions in standing stance under body weight (600 N). The largest displacement in the model was 2.94 mm, which was similar to the values in the previous studies (2.70 mm in the Phillips et al [26] and 2.71 mm in the Wu et al [27]). The regions of stress concentration were observed at the superior rim of the acetabulum and on the ilium superior to the acetabulum, which was agreement with previous models.…”

“…Upward or slip displacements, which are produced by the push of the femoral head-acetabular roof, reflect the overall standing stability of the hip. [27] The posterior wall fracture under the third fixation system has the minimum difference response compared to the normal model. Additionally, the upward displacement difference under the third fixation system was no longer statistically different from the normal model.…”

Biomechanical Evaluation of a New Fixation Type in 3D-Printed Periacetabular Implants using a Finite Element Simulation

“…This study demonstrated that the horseshoe-shaped plate model exhibited a more stable fixation than the conventional straight-type plate model in the pelvic implant fixation. For the fixation of a pelvic bone fracture, previous investigators have developed various fixation systems by incorporating screws or another plate into the fixation system with a column plate [13,14,29,30]. In addition to the pelvic implant fixation, our horseshoe-shaped plate model could be beneficial to enhance the stabilities of the fixation system in the pelvic bone fracture.…”