Biomechanical Comparison of Intrapelvic and Extrapelvic Fixation for Acetabular Fractures Involving the Quadrilateral Plate

Gillispie, Gregory J.; Babcock, Sharon; McNamara, K.; Dimoff, Michaela E.; Aneja, Arun; Brown, Philip J.; Carroll, Eben A.

doi:10.1097/bot.0000000000000963

Cited by 20 publications

(24 citation statements)

References 44 publications

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“…With ORIF, the quadrilateral surface is addressed as part of the reduction process. Non-anatomical reduction and articular incongruence lead to early secondary osteoarthritis [35]. In our experience, also primary anatomical reposition and fixation led to secondary medial displacement using suprapectineal plating without medial buttressing.…”

Section: Discussionmentioning

confidence: 52%

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Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

et al. 2020

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Background In geriatric acetabular fractures, the quadrilateral plate is often involved in the fracture pattern and medially displaced. Open reduction and internal fixation (ORIF) includes reduction of the quadrilateral plate and securing its position. In this study, the concept of medial buttressing in acute and periprosthetic acetabular fractures is evaluated. Materials and methods Patients, who sustained an acetabular fracture between 2012 and 2018, in whom ORIF with a specific implant for medial buttressing was performed, were included in the study. Patients were divided in two groups; acute acetabular fractures (group 1) and periprosthetic acetabular fractures (group 2). Demographics, type of fracture, surgical approach, type of implant for medial buttressing, comorbidities, general and surgical in-hospital complications and length of hospital stay were recorded retrospectively. The following data were collected from the surviving patients by telephone interview: EQ-5D-5L, SF-8 physical and SF-8 mental before trauma and at follow-up, UCLA activity scale, Parker Mobility Score and Numeric Rating Scale. Results Forty-six patients were included in this study, 30 males (65.2%) and 16 females (34.8%). Forty patients were included group 1 and six patients in group 2. The median age of patients of group 1 was 78 years. Among them, 82.5% presented with comorbidities. Their median length of in-hospital stay was 20.5 days. 57.5% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all but one patient. ORIF together with primary total hip arthroplasty (THA) was carried out as a single stage procedure in 3 patients. Secondary THA was performed in 5 additional patients (5/37 = 13.5%) within the observation period. Among surviving patients, 79.2% were evaluated after 3 years of follow-up. Quality of life, activity level and mobility dropped importantly and were lower than the values of a German reference population. SF-8 mental did not change. The median age of patients of group 2 was 79.5 years, all of them presented with one or several comorbidities. The median length of in-hospital stay was 18.5 days. 50% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all patients. 5 of 6 patients (83.3%) could be evaluated after a median of 136 weeks. In none of these patients, secondary surgery was necessary. Quality of life, activity level and mobility importantly dropped as well in this group. SF-8 mental remained unchanged. Conclusion In geriatric acetabular fractures with involvement and medial displacement of the quadrilateral plate, medial buttressing as part of ORIF proved to be reliable. Only 13.5% of patients of group 1 needed a secondary THA within 3 years of follow-up, which is lower than in comparable studies. Despite successful surgery, quality of life, activity level and mobility dropped importantly in all patients. The loss of independence did however not influence SF-8 mental values.

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Section: Discussionmentioning

confidence: 52%

“…The superior biomechanical properties of medial buttress-implants have been proven in several studies [35,36]. In a recent paper, Chen et al favorize the use of suprapectineal plates…”

Section: Discussionmentioning

confidence: 99%

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

et al. 2020

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“…The three aforementioned conventional treatment methods also have certain limitations in treating low posterior column fractures. Some authors have described inserting articular screws from the pubic bone to the anterior acetabular edge by the anterior approach to achieve fixation [ 19 ]. However, posterior column fracture displacement is not a simple inward movement, but rotational displacement.…”

Section: Discussionmentioning

confidence: 99%

Oblique-ilioischial plate technique: a novel method for acetabular fractures involving low posterior column

Chen

et al. 2022

BMC Musculoskelet Disord

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Background Complex acetabular fractures involving the anterior and posterior columns are an intractable clinical challenge. The study investigated the safety and efficacy of oblique-ilioischial plate technique for acetabular fractures involving low posterior column. Methods A retrospective analysis of 18 patients operated with the oblique-ilioischial plate technique by the modified Stoppa approach (or combined with iliac fossa approach) between August 2016 and July 2021 for low posterior column acetabular fractures was conducted. The anterior column was fixed with a reconstructed plate from the iliac wing along the iliopectineal line to the pubis. The low posterior column was fixed with the novel oblique-ilioischial plate running from the ilium to the ischial ramus. Operative time, intraoperative blood loss, reduction quality, and postoperative hip function were recorded. Results Out of the 18 patients, 10 were male and 8 were female. The mean age was 48.6±10.2 years (range: 45–62 years); The mean interval from injury to operation was 7.2±1.4 days (range: 5–19 days); The mean operative time was 2.1±0.3 h (range: 1.0–3.2 hours); The mean intraoperative blood loss was 300±58.4 mL (range: 200–500 mL). Postoperative reduction (Matta’s criteria) was deemed as excellent (n = 9), good (n = 4), and fair (n = 5). At the final follow-up, the hip function (modified Merle d’Aubigne-Postel scale) was deemed as excellent (n = 11), good (n = 3), and fair (n = 4). The mean union time was 4.5±1.8 months (range: 3–6 months). No implant failure, infection, heterotopic ossification, or neurovascular injury were reported. Conclusion The oblique-ilioischial plate technique via anterior approach for acetabular fractures involving low posterior column offers reliable fixation, limited invasion, little intraoperative bleeding, and fewer complications. However, larger multicenter control studies are warranted.

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“…The three aforementioned conventional treatment methods also have certain limitations in treating low level posterior column fractures. Some authors have described inserting articular screws from the pubic bone to the anterior acetabular edge by the anterior approach to achieve xation [17]. However, posterior column fracture displacement is not a simple inward movement, but rotational displacement.…”

Section: Discussionmentioning

confidence: 99%

Oblique-ilioischial Plate Technique: A Novel Method for Acetabular Fractures Involving Low Level Posterior Column

Zhong

Chen

et al. 2021

Preprint

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Background: Complex acetabular fractures involving the anterior and posterior columns are an intractable clinical challenge. The study investigated the safety and efficacy of oblique-ilioischial plate technique for acetabular fractures involving low level posterior column. Methods: A retrospective analysis of 18 patients operated with the oblique-ilioischial plate technique by the modified Stoppa approach (or combined with iliac fossa approach) between August 2016 and July 2021 for low level posterior column acetabular fractures was conducted. The anterior column was fixed with a reconstructed plate from the iliac wing along the iliopectineal line to the pubis. The low level posterior column was fixed with the novel oblique-ilioischial plate running from the ilium to the ischial ramus. Operative time, intraoperative blood loss, reduction quality, and postoperative hip function were recorded.Results: Out of the 18 patients, 10 were male and 8 were female (mean age: 48.6±10.2 years, range: 45–62 years; mean interval from injury to operation: 7.2±1.4 days, range: 5–19 days; mean operative time: 2.1±0.3 h, range: 1. 0–3.2 hours; mean intraoperative blood loss: 300±58.4 mL, range: 200–500 mL). Postoperative reduction (Matta’s criteria) was deemed as excellent (n = 9), good (n = 4), and fair (n = 5). At the final follow-up, the hip function (modified Merle d’Aubigne-Postel scale) was deemed as excellent (n = 11), good (n = 3), and fair (n = 4). The mean union time was 4.5±1.8 months (range: 3–6 months). No implant failure, infection, heterotopic ossification, or neurovascular injury were reported. Conclusion: The oblique-ilioischial plate technique via anterior approach for acetabular fractures involving low level posterior column offers reliable fixation, limited invasion, little intraoperative bleeding, and fewer complications. However, larger multicenter control studies are warranted.

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Biomechanical Comparison of Intrapelvic and Extrapelvic Fixation for Acetabular Fractures Involving the Quadrilateral Plate

Abstract: These findings demonstrate that the addition of intrapelvic plating may offer distinct advantages in prevention of catastrophic construct failure in situations in which significant lateral to medial force is applied to the greater trochanter such as patient falling.

Cited by 20 publications

References 44 publications

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

Oblique-ilioischial plate technique: a novel method for acetabular fractures involving low posterior column

Oblique-ilioischial Plate Technique: A Novel Method for Acetabular Fractures Involving Low Level Posterior Column

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