Fixation of acetabular fractures with quadrilateral plate involvement using intrapelvic reduction and buttress plate via modified stoppa approach: A clinico-radiological and functional outcome evaluation

Abstract

Acetabular fractures with quadrilateral plate involvement form a heterogeneous group of fractures which are not specifically defined by any current classification system. Surgical treatment of these fractures poses a challenge to Orthopaedic surgeons. The aim of this study was to evaluate the efficacy, safety and outcomes of the fixation technique by using IRBP for acetabular fractures with quadrilateral plate involvement via single modified Stoppa approach. A total of 30 patients with acetabular quadrilateral plate fracture, selected between January 2016 to June 2019, were managed by IRBP via modified Stoppa approach. This was a prospective study and all patients were followed up to a minimum of 2 years. The primary outcome measures were reduction quality and functional outcome which were evaluated according to Matta’s radiological criteria and modified Merle d’Aubigné and Postel score respectively. Secondary outcomes were intra-operative conditions such as operative time and blood loss and post-operative complications.Anatomic reduction was obtained in 22 (73.3%), Imperfect in 6 (20%), and Poor in 2 (6.7%) cases. The modified Merle d’Aubigné and Postel score outcomes were Excellent to Good in 25 (83.3%) patients, Fair in 3 (10%), and Poor in 2 (6.7%) with the mean score being 16.07 ± 2.68. 21 (70%) patients did not have any complications. None of the cases had quadrilateral screws entering the hip joint.The use of IRBP system is an effective and safe choice for acetabular fractures with quadrilateral plate involvement done via modified Stoppa approach as it has low rate of complications, addresses multiple fractures of acetabulum through a single approach and provides good functional and radiological outcomes over long term.